Provider Demographics
NPI:1144353608
Name:EVERETT, CARSON H (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:H
Last Name:EVERETT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3233
Mailing Address - Country:US
Mailing Address - Phone:972-881-7148
Mailing Address - Fax:
Practice Address - Street 1:1705 AUDIE MURPHY PKWY
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442
Practice Address - Country:US
Practice Address - Phone:903-583-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist