Provider Demographics
NPI:1144820663
Name:ELLERMAN, ASHTON B (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:B
Last Name:ELLERMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 KIMMELL RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6341
Mailing Address - Country:US
Mailing Address - Phone:812-886-0006
Mailing Address - Fax:
Practice Address - Street 1:650 KIMMELL RD
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-6341
Practice Address - Country:US
Practice Address - Phone:812-886-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023665A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist