Ethan Pennywitt, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302414620 Issued in MI

Practice address

419 W Main St
Gaylord, MI 49735-1859

Phone

(989) 732-5220

NPI assigned

Aug 30, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rite Aid of Michigan Inc

  • Community/Retail Pharmacy
  • Washington, MI
  • NPI 1619117405
  NPD (past)
• Rite Aid of Michigan Inc

  • Community/Retail Pharmacy
  • Gaylord, MI
  • NPI 1669581112
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1023738077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SILVER PINE CIR APT 30",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359804",
            "telephone_number": "419-973-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W MAIN ST",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351859",
            "telephone_number": "989-732-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYWITT",
        "first_name": "ETHAN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302414620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Anne Peacock, CPNP-PC
• Mary Ann Pearall, RD
• Cathryn Gerian Pearl, PA-C
• Bailey Elise Pearson, OD
• Seth Pelkie
• Mariana L Perinot, MD
• Lisa Tanya Perreault
• Michelle Perri
• Anna Maree Perry, BEHAVIOR TECHNICIAN
• Julia Alexandra-Saldana Perry, LPC

• Pharmacist in Gaylord, MI
• Providers in Gaylord, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.