Provider Demographics
NPI:1164455085
Name:EVERETT PHARMACY INC
Entity Type:Organization
Organization Name:EVERETT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-652-6745
Mailing Address - Street 1:108 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1292
Mailing Address - Country:US
Mailing Address - Phone:814-652-5532
Mailing Address - Fax:814-652-2927
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1292
Practice Address - Country:US
Practice Address - Phone:814-652-5532
Practice Address - Fax:814-652-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410712L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007282180003Medicaid
PA3900289OtherNABP NCPTP
PA3900289OtherNABP NCPTP