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General NPI Number Information
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NPI Number | 1467041731
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Entity Type | Individual
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Provider Name | SUSAN DAVIS RPH
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 42 WINDSOR AVE
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City | VERNON ROCKVILLE
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State | CT
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Zip | 06066-6606
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Country | US
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Telephone | 860-875-9263
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Fax |
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Provider Business Mailing Address
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Address Line | 2 UPPER MDW
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City | GRANBY
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State | CT
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Zip | 06035-2937
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Country | US
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Telephone | 860-402-8230
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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 | CT8761
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License Number State | CT
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