MEDICARE: DR. MARK DAVIS PHARM D

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
1	183500000X	Pharmacist	RP439438	PA

General Provider Information

NPI Number	:	1295053254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DAVIS PHARM D

Provider Business Mailing Address
First Line	:	101 EQUESTRIAN DR
Second Line	:
City	:	VENETIA
State	:	PA
Zip	:	15367-1189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4185 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-942-9111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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