Basic Information
Provider Information
NPI: 1225386592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LITTLE
FirstName: ASHLEY
MiddleName: ELIZABETH
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2900 VETERANS WAY
Address2:  
City: VIERA
State: FL
PostalCode: 329408007
CountryCode: US
TelephoneNumber: 3216373788
FaxNumber:  
Practice Location
Address1: 2900 VETERANS WAY
Address2:  
City: VIERA
State: FL
PostalCode: 329408007
CountryCode: US
TelephoneNumber: 3216373788
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/16/2012
LastUpdateDate: 05/01/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPS 48791FLN Pharmacy Service ProvidersPharmacist 
1835P1300XPS 48791FLY Pharmacy Service ProvidersPharmacistPsychiatric

No ID Information.


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