MEDICARE: MICHAEL DAVIS RPH

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
1	183500000X	Pharmacist	37058	CA

General Provider Information

NPI Number	:	1417278581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVIS RPH

Provider Business Mailing Address
First Line	:	1825 S CENTRE CITY PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-6525
Country	:	US
Telephone Number	:	760-738-4236
Fax Number	:	760-738-2650

Provider Business Practice Location Address
First Line	:	1825 S CENTRE CITY PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-6525
Country	:	US
Telephone Number	:	760-738-4236
Fax Number	:	760-738-2650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	06/11/2010

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