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General NPI Number Information
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NPI Number | 1083210181
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Entity Type | Individual
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Provider Name | MARTIN DAVENPORT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 100 N 12TH ST
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City | MURRAY
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State | KY
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Zip | 42071-1912
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Country | US
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Telephone | 270-753-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 358 WATERWAY TRL
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City | NEW CONCORD
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State | KY
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Zip | 42076-4826
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Country | US
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Telephone | 270-227-2911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 010140
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License Number State | KY
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