=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548848138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBINA S DAVYDOVSKAYA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2021
-----------------------------------------------------
Last Update Date | 04/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7235 MARKET PLACE DR
-----------------------------------------------------
City | REMINDERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44202-8758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-562-7084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33075 WAGON WHEEL DR
-----------------------------------------------------
City | SOLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44139-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-539-1056
-----------------------------------------------------
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 | 03230573
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------