Provider Demographics
NPI:1700154655
Name:ETTIENNE, EARL (RPH)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:ETTIENNE
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 1:10305 ACKERLY TER
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2352
Mailing Address - Country:US
Mailing Address - Phone:301-552-8393
Mailing Address - Fax:
Practice Address - Street 1:10305 ACKERLY TER
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2352
Practice Address - Country:US
Practice Address - Phone:301-552-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist