Healthcare Provider Details

I. General information

NPI: 1104089994
Provider Name (Legal Business Name): BRIAN JOHN DAVIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CALIFORNIA ST LAUREL HEIGHTS ANNEX 40
SAN FRANCISCO CA
94118-1210
US

IV. Provider business mailing address

3333 CALIFORNIA ST LAUREL HEIGHTS ANNEX 40
SAN FRANCISCO CA
94118-1210
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1443
  • Fax: 415-502-4144
Mailing address:
  • Phone: 415-476-1443
  • Fax: 415-502-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH57892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: