Provider Demographics
NPI:1306193974
Name:EVERETT, DANIEL JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAY
Last Name:EVERETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SW RYAN CT
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2076
Mailing Address - Country:US
Mailing Address - Phone:509-334-4166
Mailing Address - Fax:
Practice Address - Street 1:1027 SW RYAN CT
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2076
Practice Address - Country:US
Practice Address - Phone:509-334-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017277183500000X
IDP4975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist