Provider Demographics
NPI:1578830030
Name:GREENUP, EVERETT D (PHARM D)
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:D
Last Name:GREENUP
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22809 E COUNTRY VISTA DR APT 323
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7573
Mailing Address - Country:US
Mailing Address - Phone:253-225-7574
Mailing Address - Fax:
Practice Address - Street 1:10618 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3634
Practice Address - Country:US
Practice Address - Phone:509-924-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist