Ethan Vandersand

NPI #1316297088 in Jerseyville, Illinois

Provider Information

NPI Number: 1316297088
Entity Type: Individual
Name: Ethan Vandersand
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Sep 10, 2012
Last Updated: Sep 10, 2012

Practice Location

Address: 400A W CARPENTER ST
City: Jerseyville
State: Illinois
ZIP Code: 62052-2522
Phone: (618) 498-6461

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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