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General NPI Number Information
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NPI Number | 1700760857
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Entity Type | Individual
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Provider Name | GARRETT WAYNE DAVIDSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 913-850-9845
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Fax |
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Provider Business Mailing Address
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Address Line | 31215 W 311TH ST
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City | PAOLA
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State | KS
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Zip | 66071-4952
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Country | US
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Telephone | 913-850-9845
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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 | 1835C0205X
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Taxonomy Name | Critical Care Pharmacist
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License Number | 1-106759
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1835C0205X
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Taxonomy Name | Critical Care Pharmacist
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License Number | 2024026600
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1835C0205X
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Taxonomy Name | Critical Care Pharmacist
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License Number | RP00010330
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License Number State | NM
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