Individual
ETHAN STOBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3926 GOODMAN RD W, HORN LAKE, MS 38637-1324
(662) 393-7868
Mailing address
3926 GOODMAN RD W, HORN LAKE, MS 38637-1324
(662) 393-7868
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-14458
MS
Other
Enumeration date
12/10/2019
Last updated
12/10/2019
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