Provider Demographics
NPI:1952905044
Name:NED, ETINYENE C (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETINYENE
Middle Name:C
Last Name:NED
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2882 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8835
Mailing Address - Country:US
Mailing Address - Phone:817-453-4080
Mailing Address - Fax:
Practice Address - Street 1:6406 VALLEYBROOKE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-8300
Practice Address - Country:US
Practice Address - Phone:682-241-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67391OtherTEXAS STATE BOARD OF PHARMACY