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General NPI Number Information
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NPI Number | 1962700435
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Entity Type | Individual
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Provider Name | JIM EVERETT
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Gender | Male
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 417 HIGHWAY 277 N
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City | SONORA
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State | TX
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Zip | 76950-2204
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Country | US
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Telephone | 325-387-2541
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Fax | 325-387-5423
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Provider Business Mailing Address
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Address Line | P.O. BOX 527
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City | SONORA
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State | TX
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Zip | 76950-0527
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Country | US
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Telephone | 325-387-2541
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Fax | 325-387-5423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18546
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 23182
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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