Provider Demographics
NPI:1386460699
Name:GENTILE, ETHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:GENTILE
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 1:7 TRIMTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1932
Mailing Address - Country:US
Mailing Address - Phone:401-301-7192
Mailing Address - Fax:
Practice Address - Street 1:7 TRIMTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1932
Practice Address - Country:US
Practice Address - Phone:401-301-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist