Healthcare Provider Details

I. General information

NPI: 1235889411
Provider Name (Legal Business Name): PEYTON DAVIS BEAVERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEYTON DEBORAH DAVIS PHARMD

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S JACKSON ST
LOUISVILLE KY
40202-3229
US

IV. Provider business mailing address

800 ROSE ST RM H110
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-4673
  • Fax:
Mailing address:
  • Phone: 859-323-4756
  • Fax: 859-323-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number022827
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: