Provider Demographics
NPI:1841817004
Name:EVERETTE, CHANDLER M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:M
Last Name:EVERETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 E CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2376
Mailing Address - Country:US
Mailing Address - Phone:704-694-2153
Mailing Address - Fax:
Practice Address - Street 1:1156 E CASWELL ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2376
Practice Address - Country:US
Practice Address - Phone:704-694-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist