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NPI Code Detail

MEDICARE: MR. ALAN DALE EVERETT RPH

MEDICARE:  MR. ALAN DALE EVERETT  RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist12391AL

General Provider Information

NPI Number : 1124362579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALAN DALE EVERETT RPH
Provider Business Mailing Address
First Line : 1613 GLENN BLVD SW
Second Line :
City : FORT PAYNE
State : AL
Zip : 35968-3531
Country : US
Telephone Number : 256-845-0128
Fax Number :
Provider Business Practice Location Address
First Line : 1613 GLENN BLVD SW
Second Line :
City : FORT PAYNE
State : AL
Zip : 35968-3531
Country : US
Telephone Number : 256-845-0128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2012
Last Update Date : 11/23/2012

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Directions to “ MR. ALAN DALE EVERETT RPH” Practice Location

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