Healthcare Provider Details

I. General information

NPI: 1174958813
Provider Name (Legal Business Name): JEFFREY PAUL DAVIS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 KRUGER ST
WHEELING WV
26003-5120
US

IV. Provider business mailing address

56 HARLEY LN
NEW CUMBERLAND WV
26047-3156
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-9306
  • Fax: 304-242-9462
Mailing address:
  • Phone: 304-670-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008193
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: