Derek Madison Ethridge, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

30227 Issued in TX

Practice address

19450 McDonald St Ste 102
Lytle, TX 78052-3649

Phone

(830) 988-0100

Fax

(830) 988-0111

NPI assigned

Feb 3, 2021

Last updated

Feb 3, 2021By the provider in NPPES

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

Registered Pharmacist

State licenses

Practice roles

Locations

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

• Shri Durga Drugs, LLC

  dba devine's crawford rx

  • Pharmacy
  • Devine, TX
  • NPI 1750854022
  NPD

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1700478575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1757 SUNFLOWER BLF",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781301958",
            "telephone_number": "210-364-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19450 MCDONALD ST STE 102",
            "city": "LYTLE",
            "state": "TX",
            "postal_code": "780523649",
            "telephone_number": "830-988-0100",
            "fax_number": "830-988-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "DEREK",
        "middle_name": "MADISON",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "30227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CRW Healthcare, LLC (Country Compassion Hospice)
• CVS Pharmacy Inc (CVS Pharmacy #10843)
• Dr. Marvin Sanchez, DPM, Podiatric Medicine
• Rosemary Eldrige, LMSW
• Kendall Nicole Escobar, CSFA
• Sandra Kay Fleming, LPCS
• Dana Flores, PHYSICAL THERAPIST
• Monica R Flores
• Saralyn Fischel Foster, RD
• Olugbenga Akanni Fowowe

• Pharmacist in Lytle, TX
• Providers in Lytle, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.