Provider Demographics
NPI:1871813592
Name:HARRY EVERETT CORPORATION
Entity type:Organization
Organization Name:HARRY EVERETT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-322-0001
Mailing Address - Street 1:5453 W 61ST PL
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3002
Mailing Address - Country:US
Mailing Address - Phone:913-322-0001
Mailing Address - Fax:913-322-0002
Practice Address - Street 1:5453 W 61ST PL
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-3002
Practice Address - Country:US
Practice Address - Phone:913-322-0001
Practice Address - Fax:913-322-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRY EVERETT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-100303336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy