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General NPI Number Information
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NPI Number | 1477924272
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Entity Type | Individual
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Provider Name | JORDAN LEE DAVIS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 7670 MARTINSBURG PIKE SUITE 2
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-3698
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Country | US
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Telephone | 304-876-9966
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Fax | 304-876-6655
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Provider Business Mailing Address
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Address Line | 7670 MARTINSBURG PIKE SUITE 2
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-3698
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Country | US
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Telephone | 304-876-9966
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Fax | 304-876-6655
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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 | 0202211171
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0009421
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 016157
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | R2365
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023703
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License Number State | GA
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