Provider Demographics
NPI:1144638628
Name:DEVORE, ASHTON BROOKE
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:BROOKE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 VESTAVIA PARK CT APT G
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3217
Mailing Address - Country:US
Mailing Address - Phone:270-774-1781
Mailing Address - Fax:
Practice Address - Street 1:2054 VESTAVIA PARK CT APT G
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3217
Practice Address - Country:US
Practice Address - Phone:270-774-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17808183500000X
KY017242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist