Provider Demographics
NPI:1497348072
Name:DUNAWAY, EVERETT LANE
Entity Type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:LANE
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SNOWDEN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7496
Mailing Address - Country:US
Mailing Address - Phone:606-548-1953
Mailing Address - Fax:
Practice Address - Street 1:265 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7370
Practice Address - Country:US
Practice Address - Phone:606-666-5519
Practice Address - Fax:606-666-9371
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106191835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care