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1174127088 NPI number — MICHAEL JOSEPH DAVIS RPH

NPI Number: 1174127088
Health Care Provider/Practitioner: MICHAEL JOSEPH DAVIS RPH

Information about “1174127088” NPI (MICHAEL JOSEPH DAVIS RPH) exists in 1174127088 in HTML format HTML  |  1174127088 in plain Text format TXT  |  1174127088 in PDF (Portable Document Format) PDF  |  1174127088 in an XML format XML  formats.

NPI Number : 1174127088 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174127088",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "MICHAEL",
    "MiddleName": "JOSEPH",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "412 BONSALL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIDLEY PARK",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19078-2701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-331-5204",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1405 S 10TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHILADELPHIA",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19147-5608",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-465-2130",
    "PracticeLocationAddressFaxNumber": "215-465-0899",
    "EnumerationDate": "11/23/2020",
    "LastUpdateDate": "11/23/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "RP043299L",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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