Provider Demographics
NPI:1023413804
Name:ETHRIDGE, JENNIFER WEATHERS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WEATHERS
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 ROBINWOOD RD
Mailing Address - Street 2:BOX B-212
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1693
Mailing Address - Country:US
Mailing Address - Phone:704-865-9480
Mailing Address - Fax:704-865-5480
Practice Address - Street 1:1351 ROBINWOOD RD
Practice Address - Street 2:BOX B-212
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1693
Practice Address - Country:US
Practice Address - Phone:704-865-9480
Practice Address - Fax:704-865-5480
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist