Provider Demographics
NPI:1114904463
Name:EVERETT, EDNA M (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:M
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
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Mailing Address - Street 1:7038 LARAMIE LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3118
Mailing Address - Country:US
Mailing Address - Phone:361-992-5865
Mailing Address - Fax:361-961-2499
Practice Address - Street 1:10651 E ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5130
Practice Address - Country:US
Practice Address - Phone:361-961-3186
Practice Address - Fax:361-961-2499
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX22406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist