Provider Demographics
NPI:1154089399
Name:DARCY, ETHAN JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
Last Name:DARCY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 RADFORD LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6200
Mailing Address - Country:US
Mailing Address - Phone:770-841-9168
Mailing Address - Fax:
Practice Address - Street 1:3093 STEVE REYNOLDS BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4501
Practice Address - Country:US
Practice Address - Phone:770-225-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist