Healthcare Provider Details

I. General information

NPI: 1073973152
Provider Name (Legal Business Name): SONYA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
YALE MI
48097-3317
US

IV. Provider business mailing address

25 S MAIN ST
YALE MI
48097-3317
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-4244
  • Fax:
Mailing address:
  • Phone: 810-387-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303007686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: