Provider Demographics
NPI:1598365983
Name:EVERETT, DONALD JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:EVERETT
Suffix:JR
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 1:2633 OLD BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-9611
Mailing Address - Country:US
Mailing Address - Phone:215-651-6665
Mailing Address - Fax:
Practice Address - Street 1:195 N WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2306
Practice Address - Country:US
Practice Address - Phone:215-529-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist