Provider Demographics
NPI:1619603842
Name:CASE, ETHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:CASE
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 1:13600 S BLACKBOB RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1934
Mailing Address - Country:US
Mailing Address - Phone:913-782-2039
Mailing Address - Fax:
Practice Address - Street 1:13600 S BLACKBOB RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1934
Practice Address - Country:US
Practice Address - Phone:913-782-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-118275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist