Healthcare Provider Details

I. General information

NPI: 1760471833
Provider Name (Legal Business Name): BRANDILYN ANN DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 COLES BLVD
PORTSMOUTH OH
45662-2643
US

IV. Provider business mailing address

1902 FRANKLIN BLVD
PORTSMOUTH OH
45662-3109
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-1148
  • Fax:
Mailing address:
  • Phone: 740-464-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-25892
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03325892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: