Provider Demographics
NPI:1649508532
Name:EVERETT, JOHN ALLEN JR (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:EVERETT
Suffix:JR
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 1:3803 RAMBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7020
Mailing Address - Country:US
Mailing Address - Phone:281-431-6486
Mailing Address - Fax:
Practice Address - Street 1:3403 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5202
Practice Address - Country:US
Practice Address - Phone:281-438-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist