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General NPI Number Information
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NPI Number | 1649663238
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Entity Type | Individual
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Provider Name | MARANDA DAVIS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 201 S PRICKLY PEAR AVE
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City | BENSON
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State | AZ
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Zip | 85602-6446
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Country | US
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Telephone | 520-586-0754
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Fax | 520-586-0756
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Provider Business Mailing Address
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Address Line | 201 S PRICKLY PEAR AVE
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City | BENSON
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State | AZ
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Zip | 85602-6446
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Country | US
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Telephone | 520-586-0754
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Fax | 520-586-0756
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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 | S014952
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License Number State | AZ
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