Provider Demographics
NPI:1154971133
Name:LAMBERT, AVERY ETHAN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:AVERY
Middle Name:ETHAN
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3524
Mailing Address - Country:US
Mailing Address - Phone:843-464-0372
Mailing Address - Fax:843-464-2729
Practice Address - Street 1:236 W MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3524
Practice Address - Country:US
Practice Address - Phone:843-464-0372
Practice Address - Fax:843-464-2729
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty