Provider Demographics
NPI:1376987891
Name:EVERHART, DOUGLAS A (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:EVERHART
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 1:1842 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1333
Mailing Address - Country:US
Mailing Address - Phone:970-494-6950
Mailing Address - Fax:970-494-6952
Practice Address - Street 1:1842 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1333
Practice Address - Country:US
Practice Address - Phone:970-494-6950
Practice Address - Fax:970-494-6952
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist