Individual
ETINYENE C NED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
6406 VALLEYBROOKE CT, ARLINGTON, TX 76001-8300
(682) 241-7847
Mailing address
2882 HIGHWAY 157 N, MANSFIELD, TX 76063-8835
(817) 453-4080
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
67391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67391
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
11/30/2020
Last updated
11/30/2020
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