Provider Demographics
NPI:1942088067
Name:DUMAS, ETHAN JAMES (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
Last Name:DUMAS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 OAKWOOD AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-1710
Mailing Address - Country:US
Mailing Address - Phone:518-651-6215
Mailing Address - Fax:
Practice Address - Street 1:442 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2245
Practice Address - Country:US
Practice Address - Phone:518-346-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist