Healthcare Provider Details

I. General information

NPI: 1700760857
Provider Name (Legal Business Name): GARRETT WAYNE DAVIDSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

31215 W 311TH ST
PAOLA KS
66071-4952
US

V. Phone/Fax

Practice location:
  • Phone: 913-850-9845
  • Fax:
Mailing address:
  • Phone: 913-850-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number1-106759
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number2024026600
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRP00010330
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: