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NPI Code Detail

MEDICARE: DR. TY JEFFERY DAVIDSON PHARMD

MEDICARE: DR. TY JEFFERY DAVIDSON PHARMD
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
1183500000XPharmacistPH00064235WA

General Provider Information

NPI Number : 1659396638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TY JEFFERY DAVIDSON PHARMD
Provider Business Mailing Address
First Line : 2533 E PERSHING CT
Second Line :
City : SHELTON
State : WA
Zip : 98584-1212
Country : US
Telephone Number : 360-427-8640
Fax Number :
Provider Business Practice Location Address
First Line : 207 PROFESSIONAL WAY
Second Line :
City : SHELTON
State : WA
Zip : 98584-4404
Country : US
Telephone Number : 360-426-4272
Fax Number : 360-426-6977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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