Provider Demographics
NPI:1508358490
Name:SZCZEPANSKI, ETHAN JARRETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JARRETT
Last Name:SZCZEPANSKI
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 1:2370 SW ARCHER RD APT 55
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1057
Mailing Address - Country:US
Mailing Address - Phone:215-421-4414
Mailing Address - Fax:
Practice Address - Street 1:900 NW 76TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6747
Practice Address - Country:US
Practice Address - Phone:352-332-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS54565OtherDEPT OF HEALTH