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NPI Code Detail

MEDICARE: JERRY BERNARD DAVIS R.PH.

MEDICARE: JERRY BERNARD DAVIS R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist32614TX

General Provider Information

NPI Number : 1225365265
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY BERNARD DAVIS R.PH.
Provider Business Mailing Address
First Line : 7215 RIVERBROOK CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-6793
Country : US
Telephone Number : 817-467-0789
Fax Number :
Provider Business Practice Location Address
First Line : 6551 FOREST HILL DR
Second Line :
City : FOREST HILL
State : TX
Zip : 76140-1205
Country : US
Telephone Number : 817-478-2952
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2009
Last Update Date : 11/12/2009

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