Healthcare Provider Details

I. General information

NPI: 1720298961
Provider Name (Legal Business Name): DAVIS MOY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 W BELMONT AVE
CHICAGO IL
60634-4644
US

IV. Provider business mailing address

7115 W MONROE ST
NILES IL
60714-3043
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-6273
  • Fax:
Mailing address:
  • Phone: 847-965-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: