Provider Demographics
NPI:1457954521
Name:RHODES, ETHAN K (RPH)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:K
Last Name:RHODES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8900
Mailing Address - Country:US
Mailing Address - Phone:419-681-6332
Mailing Address - Fax:
Practice Address - Street 1:123 W SPRING ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1768
Practice Address - Country:US
Practice Address - Phone:513-523-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist