Healthcare Provider Details

I. General information

NPI: 1114904463
Provider Name (Legal Business Name): EDNA M. EVERETT PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10651 E ST
CORPUS CHRISTI TX
78419-5130
US

IV. Provider business mailing address

7038 LARAMIE LN
CORPUS CHRISTI TX
78414-3118
US

V. Phone/Fax

Practice location:
  • Phone: 361-961-3186
  • Fax: 361-961-2499
Mailing address:
  • Phone: 361-992-5865
  • Fax: 361-961-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: