Healthcare Provider Details

I. General information

NPI: 1225868367
Provider Name (Legal Business Name): CHRISTINE DAVIDSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 INTERSTATE DR
HORN LAKE MS
38637-1410
US

IV. Provider business mailing address

5318 PEPPERMILL DR
SOUTHAVEN MS
38671-8446
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-8336
  • Fax:
Mailing address:
  • Phone: 901-826-5023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48041
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-11890
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: