Active NPI
Ethan A. Carruthers, PHARMD
- Pharmacist
- Waupun, WI
National Provider Identifier
1871860965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16049-40
- Practice address
- 999 E Main St
Waupun, WI 53963-2210 - Phone
- (920) 324-4696
- Fax
- (920) 324-4910
- NPI assigned
- Nov 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16049-40 | WI | Primary |
Addresses
Primary practice location
999 E Main St
Waupun, WI 53963-2210
Mailing address
626 E State St
Apt 304
Milwaukee, WI 53202-3247
Phone (414) 759-2116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16049-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1871860965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 E STATE ST",
"address_2": "APT 304",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532023247",
"telephone_number": "414-759-2116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 E MAIN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539632210",
"telephone_number": "920-324-4696",
"fax_number": "920-324-4910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRUTHERS",
"first_name": "ETHAN",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-17",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "16049-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waupun, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.