Provider Demographics
NPI:1700151644
Name:ETHEREDGE, PATRICIA DALY (RPH)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DALY
Last Name:ETHEREDGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8628
Mailing Address - Country:US
Mailing Address - Phone:828-298-2890
Mailing Address - Fax:828-298-9882
Practice Address - Street 1:225 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8628
Practice Address - Country:US
Practice Address - Phone:828-298-2890
Practice Address - Fax:828-298-9882
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist