Healthcare Provider Details

I. General information

NPI: 1194789925
Provider Name (Legal Business Name): STEPHANIE JOY DAVIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE 13-119
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

3601 S 6TH AVE 13-119
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-838-3662
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-838-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9867
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9867
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number44932
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number44932
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number9867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: