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General NPI Number Information
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NPI Number | 1114083094
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Entity Type | Organization
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Legal Business Name | DAVIS PHARMACY
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 59 MAIN ST
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City | E MILLINOCKET
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State | ME
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Zip | 04430-1126
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Country | US
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Telephone | 207-746-3721
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Fax | 207-746-9230
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Provider Business Mailing Address
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Address Line | 59 MAIN ST
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City | E MILLINOCKET
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State | ME
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Zip | 04430-1126
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Country | US
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Telephone | 207-746-3721
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Fax | 207-746-9230
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Authorized Official
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Title or Position | PRES
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Name | NANCY DAVIS
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Credential | RPH
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Telephone | 207-746-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH50000305
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License Number State | ME
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