=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205161767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA DAVIS PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2009
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7828 PINEVILLE MATTHEWS RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28226-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-341-2019
-----------------------------------------------------
Fax | 704-341-6170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7828 PINEVILLE MATTHEWS RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28226-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-341-2019
-----------------------------------------------------
Fax | 704-341-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17999
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------