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NPI Code Detail

MEDICARE: ANNA C DAVENPORT PHARMD

MEDICARE: ANNA C DAVENPORT PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist119421MN

General Provider Information

NPI Number : 1225204811
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA C DAVENPORT PHARMD
Provider Business Mailing Address
First Line : 2500 E LAKE ST
Second Line : T-0052
City : MINNEAPOLIS
State : MN
Zip : 55406-1909
Country : US
Telephone Number : 612-203-2487
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E LAKE ST
Second Line : T-0052
City : MINNEAPOLIS
State : MN
Zip : 55406-1909
Country : US
Telephone Number : 651-704-0322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2008
Last Update Date : 11/21/2012

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