Healthcare Provider Details

I. General information

NPI: 1679306310
Provider Name (Legal Business Name): SHAKEYIA BRIANNA DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W PARK AVE
GREENWOOD MS
38930-2910
US

IV. Provider business mailing address

700 W PARK AVE
GREENWOOD MS
38930-2910
US

V. Phone/Fax

Practice location:
  • Phone: 662-846-5781
  • Fax:
Mailing address:
  • Phone: 662-451-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-101649
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: