Individual
MR. LARRY ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
4240 LUTHER WARD RD, POWDER SPRINGS, GA 30127-1184
(770) 726-9837
(770) 726-9837
Mailing address
4240 LUTHER WARD RD, POWDER SPRINGS, GA 30127-1184
(770) 726-9837
(770) 726-9837
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH010737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH010737
PHARMACY LICENSE
GA
Enumeration date
11/14/2013
Last updated
11/14/2013
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