Provider Demographics
NPI:1619673639
Name:EVERETT, ALEXANDER TIMEHIN
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:TIMEHIN
Last Name:EVERETT
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 1:7208 FM 78
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1766
Mailing Address - Country:US
Mailing Address - Phone:210-666-0162
Mailing Address - Fax:210-666-0592
Practice Address - Street 1:7208 FM 78
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1766
Practice Address - Country:US
Practice Address - Phone:210-666-0162
Practice Address - Fax:210-666-0592
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist