Healthcare Provider Details

I. General information

NPI: 1992798565
Provider Name (Legal Business Name): STEVEN LEWIS DAVIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 DEFIANCE ST
WAPAKONETA OH
45895-1081
US

IV. Provider business mailing address

1516 MADISON PL
WAPAKONETA OH
45895-7200
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-5958
  • Fax: 419-738-3019
Mailing address:
  • Phone: 419-738-6674
  • Fax: 419-738-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-09076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: