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Deactivated NPI 1336120872 Deactivated / Inactive NPI Male Practitioner

Robert W. Ethridge , RPH, CPH

Pharmacist • Daytona Beach, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Robert Ethridge has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 10, 2005
NPI Deactivation Date February 17, 2020
Total Practice Duration ~15 Years of Practice (2005 – 2020)

Professional Overview & Biography Verified Profile Summary

Robert Ethridge, RPH, CPH was a registered Pharmacist practicing in Daytona Beach, FL. Throughout an active medical career spanning 15 years, Robert Ethridge provided care at the practice location at 1220 WILLIS AVE until profile deactivation on 2020-02-17.

Practice Location & Contact Primary Location

Practice Address

1220 Willis Ave
Bldg 2

Daytona Beach, FL 321142810

Telephone 3862363188
Fax 3862396123
Associated Practice Facility / Clinic
🏢 Sma Healthcare Inc Facility NPI 1417939794

Specialty Benchmarks & Practice Insights

Comparative analytics for Pharmacist in Daytona Beach, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
72 Specialists

Practicing in Daytona Beach, FL (19926 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

State License FL PS 9992

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1427665728

Doctor of Pharmacy (Pharm.D.)

Catherine Root , RN

Registered Nurse

NPI 1740287747

Registered Nurse

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated February 17, 2020

Record deactivated on February 17, 2020

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1220 WILLIS AVE, BLDG 2, DAYTONA BEACH, FL 321142810 (Tel: 3862363188)

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Updated Business Mailing Address July 08, 2007

Registered at 1220 WILLIS AVE, BLDG 2, DAYTONA BEACH, FL 321142810 (Tel: 3862363188)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ROBERT ETHRIDGE, R.PH., C.PH.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Pharmacist (License #PS 9992 in FL)

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Initial NPI Registration & Enumeration November 10, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1336120872
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 10, 2005
Last Update: July 08, 2007
Deactivation Date: February 17, 2020

Mailing Address

1220 Willis Ave, Bldg 2

Daytona Beach, FL 321142810

Phone: 3862363188

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.