Provider Demographics
NPI:1013537679
Name:MIDDLETON, ETHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:MIDDLETON
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 1:101 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMONI
Mailing Address - State:IA
Mailing Address - Zip Code:50140-1241
Mailing Address - Country:US
Mailing Address - Phone:641-784-6322
Mailing Address - Fax:641-784-6322
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1241
Practice Address - Country:US
Practice Address - Phone:641-784-6322
Practice Address - Fax:641-784-6322
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist