Individual
DEREK MADISON ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
19450 MCDONALD ST STE 102, LYTLE, TX 78052-3649
(830) 988-0100
(830) 988-0111
Mailing address
1757 SUNFLOWER BLF, NEW BRAUNFELS, TX 78130-1958
(210) 364-4441
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
30227
TX
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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