Provider Demographics
NPI:1114264041
Name:EVERLY, NANCY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:EVERLY
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 1:3015 SW PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1703
Mailing Address - Country:US
Mailing Address - Phone:239-282-5530
Mailing Address - Fax:239-282-5533
Practice Address - Street 1:3015 SW PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1703
Practice Address - Country:US
Practice Address - Phone:239-282-5530
Practice Address - Fax:239-282-5533
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist