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NPI Code Detail

MEDICARE: BRIAN DAVIS R.PH.

MEDICARE:   BRIAN  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
1183500000XPharmacistRP028418LPA

General Provider Information

NPI Number : 1750694782
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN DAVIS R.PH.
Provider Business Mailing Address
First Line : 1629 RESERVOIR AVE
Second Line :
City : WILLOW GROVE
State : PA
Zip : 19090-4434
Country : US
Telephone Number : 215-830-8747
Fax Number : 215-830-8747
Provider Business Practice Location Address
First Line : 1629 RESERVOIR AVE
Second Line :
City : WILLOW GROVE
State : PA
Zip : 19090-4434
Country : US
Telephone Number : 215-830-8747
Fax Number : 215-830-8747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2010
Last Update Date : 07/19/2010

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