Provider Demographics
NPI:1962702134
Name:EVERETT, LISSETTE DENISE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:DENISE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1543
Mailing Address - Country:US
Mailing Address - Phone:361-887-0789
Mailing Address - Fax:361-887-0826
Practice Address - Street 1:2101 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1543
Practice Address - Country:US
Practice Address - Phone:361-887-0789
Practice Address - Fax:361-887-0826
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist