Healthcare Provider Details

I. General information

NPI: 1114083094
Provider Name (Legal Business Name): DAVIS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MAIN ST
E MILLINOCKET ME
04430-1126
US

IV. Provider business mailing address

59 MAIN ST
E MILLINOCKET ME
04430-1126
US

V. Phone/Fax

Practice location:
  • Phone: 207-746-3721
  • Fax: 207-746-9230
Mailing address:
  • Phone: 207-746-3721
  • Fax: 207-746-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50000305
License Number StateME

VIII. Authorized Official

Name: NANCY DAVIS
Title or Position: PRES
Credential: RPH
Phone: 207-746-3721