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General NPI Number Information
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NPI Number | 1770904526
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Entity Type | Individual
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Provider Name | WENDY ETHRIDGE
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Gender | Female
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 4175 S PIPKIN RD SUITE 208
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City | LAKELAND
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State | FL
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Zip | 33811-1699
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Country | US
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Telephone | 866-577-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 14125 PORTRUSH DR
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City | ORLANDO
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State | FL
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Zip | 32828-8241
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Country | US
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Telephone | 407-382-8825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS35010
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PU5606
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License Number State | FL
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