Provider Demographics
NPI:1013006790
Name:HARRY EVERETT CORP
Entity Type:Organization
Organization Name:HARRY EVERETT CORP
Other - Org Name:OBRIEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GAE
Authorized Official - Last Name:EVERETT ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CCN
Authorized Official - Phone:913-322-0001
Mailing Address - Street 1:5453 W 61ST PL
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3002
Mailing Address - Country:US
Mailing Address - Phone:913-322-0001
Mailing Address - Fax:913-322-0002
Practice Address - Street 1:5453 W 61ST PL
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-3002
Practice Address - Country:US
Practice Address - Phone:913-322-0001
Practice Address - Fax:913-322-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-100303336C0004X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027796OtherPK