Provider Demographics
NPI:1235485798
Name:EVERETT, BILLY (RPH)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 EPHESUS RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-7683
Mailing Address - Country:US
Mailing Address - Phone:601-469-9454
Mailing Address - Fax:
Practice Address - Street 1:885 LIBERTY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9000
Practice Address - Country:US
Practice Address - Phone:601-714-1868
Practice Address - Fax:601-420-6866
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist