Provider Demographics
NPI:1023155314
Name:ETHRIDGE, WINONA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WINONA
Middle Name:LYNN
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:WINONA
Other - Middle Name:LYNN
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BS
Mailing Address - Street 1:108 BANNERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6300
Mailing Address - Country:US
Mailing Address - Phone:864-455-7040
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist