Individual
DR. ETHAN A. CARRUTHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
999 E MAIN ST, WAUPUN, WI 53963-2210
(920) 324-4696
(920) 324-4910
Mailing address
626 E STATE ST, APT 304, MILWAUKEE, WI 53202-3247
(414) 759-2116
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16049-40
WI
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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