Provider Demographics
NPI:1417437310
Name:PARSONS, ETHAN KYLE-JAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:KYLE-JAY
Last Name:PARSONS
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 1:8105 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8020
Mailing Address - Country:US
Mailing Address - Phone:615-221-9982
Mailing Address - Fax:
Practice Address - Street 1:8105 MOORES LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8020
Practice Address - Country:US
Practice Address - Phone:615-221-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist