Provider Demographics
NPI:1013587302
Name:EVERETT, MADISON TAYLOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:AR
Mailing Address - Zip Code:72045-9604
Mailing Address - Country:US
Mailing Address - Phone:501-581-6636
Mailing Address - Fax:501-882-1530
Practice Address - Street 1:2003 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2544
Practice Address - Country:US
Practice Address - Phone:501-882-1516
Practice Address - Fax:501-882-1530
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist