Healthcare Provider Details

I. General information

NPI: 1013006790
Provider Name (Legal Business Name): HARRY EVERETT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 W 61ST PL
MISSION KS
66205-3002
US

IV. Provider business mailing address

5453 W 61ST PL
MISSION KS
66205-3002
US

V. Phone/Fax

Practice location:
  • Phone: 913-322-0001
  • Fax: 913-322-0002
Mailing address:
  • Phone: 913-322-0001
  • Fax: 913-322-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2-10030
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA GAE EVERETT ANDERSEN
Title or Position: OWNER
Credential: RPH, CCN
Phone: 913-322-0001