Healthcare Provider Details

I. General information

NPI: 1306193974
Provider Name (Legal Business Name): DANIEL JAY EVERETT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 SW RYAN CT
PULLMAN WA
99163-2076
US

IV. Provider business mailing address

1027 SW RYAN CT
PULLMAN WA
99163-2076
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-4166
  • Fax:
Mailing address:
  • Phone: 509-334-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00017277
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4975
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: