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General NPI Number Information
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NPI Number | 1366954067
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Entity Type | Organization
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Legal Business Name | E DAVIDSON RX LLC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 4420 E DAVISON ST
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City | DETROIT
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State | MI
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Zip | 48212-1744
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Country | US
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Telephone | 313-334-6711
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Fax | 313-334-6710
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Provider Business Mailing Address
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Address Line | 6689 ORCHARD LAKE RD STE 168
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | 3RD PARTY COORDINATOR
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Name | CANDICE TOLF
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Credential |
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Telephone | 313-751-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010812
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License Number State | MI
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