Healthcare Provider Details

I. General information

NPI: 1134190762
Provider Name (Legal Business Name): MARSHALL W DAVIS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/19/2025
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LONE OAK RD
PADUCAH KY
42001-4400
US

IV. Provider business mailing address

250 LONE OAK RD
PADUCAH KY
42001-4400
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-1442
  • Fax: 270-444-0610
Mailing address:
  • Phone: 270-443-1442
  • Fax: 270-444-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01445
License Number StateKY

VIII. Authorized Official

Name: MARSHALL DAVIS
Title or Position: PRESIDENT
Credential: RPH
Phone: 270-443-1442