Provider Demographics
NPI:1902193535
Name:EVERETT, WILLIAM LEWIS (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEWIS
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 1:536 E FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2505
Mailing Address - Country:US
Mailing Address - Phone:850-682-2008
Mailing Address - Fax:850-682-4145
Practice Address - Street 1:536 E FIRST AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2505
Practice Address - Country:US
Practice Address - Phone:850-682-2008
Practice Address - Fax:850-682-4145
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS011892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS011892OtherFLORIDA BOARD OF PHARMACY LICENSE NUMBER