MEDICARE: MR. CURTIS P DAVISON JR. 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
1	183500000X	Pharmacist	23656	CA

General Provider Information

NPI Number	:	1679675250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS P DAVISON JR. R.PH.

Provider Business Mailing Address
First Line	:	904 DENVER PL
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-2148
Country	:	US
Telephone Number	:	805-647-2512
Fax Number	:	805-647-4587

Provider Business Practice Location Address
First Line	:	110 W HARVARD BLVD
Second Line	:	SUITE H
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3874
Country	:	US
Telephone Number	:	805-525-3313
Fax Number	:	805-933-9307

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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