=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255584413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN JUDITH DAVIS PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2008
-----------------------------------------------------
Last Update Date | 03/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 VETERANS WAY
-----------------------------------------------------
City | VIERA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-637-3788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 MORRIS CT
-----------------------------------------------------
City | WEST MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32904-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-676-7784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS35958
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------