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General NPI Number Information
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NPI Number | 1174265532
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Entity Type | Individual
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Provider Name | JOHNATHAN TYLER DAVIS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 2425 S ZERO ST
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City | FORT SMITH
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State | AR
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Zip | 72901-8663
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Country | US
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Telephone | 479-646-6382
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RED OAK LN
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-9068
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Country | US
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Telephone | 870-880-0777
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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 | PD13950
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License Number State | AR
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