Provider Demographics
NPI:1053942169
Name:GAGE, ASHLEY (CPHT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S WHITTAKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1763
Mailing Address - Country:US
Mailing Address - Phone:844-214-4446
Mailing Address - Fax:800-886-1521
Practice Address - Street 1:447 S WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1763
Practice Address - Country:US
Practice Address - Phone:844-214-4446
Practice Address - Fax:800-886-1521
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303030018TMP19183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician