Healthcare Provider Details

I. General information

NPI: 1174640064
Provider Name (Legal Business Name): DEBRA L DAVIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 S CEDAR AVE
OWATONNA MN
55060-4302
US

IV. Provider business mailing address

1929 S CEDAR AVE
OWATONNA MN
55060-4302
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-0240
  • Fax: 507-451-5134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number114643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: