Provider Demographics
NPI:1205182375
Name:EVERETT, LISA G (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:913-322-0001
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:913-322-0001
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0158511835N1003X
MO0295331835N1003X
KS1-141331835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support