1821380684 NPI number — EVERETT DILLARD WHITSON RPH PHARMD.

Table of content: EVERETT DILLARD WHITSON RPH PHARMD. (NPI 1821380684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821380684 NPI number — EVERETT DILLARD WHITSON RPH PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITSON
Provider First Name:
EVERETT
Provider Middle Name:
DILLARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH PHARMD.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITSON
Provider Other First Name:
EVERETT
Provider Other Middle Name:
DILLARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821380684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 OLD GAINESBORO HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-8939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-267-0993
Provider Business Mailing Address Fax Number:
931-243-4691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GAINESBORO HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-243-2673
Provider Business Practice Location Address Fax Number:
931-243-4691
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0000007427 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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