MEDICARE: SARA DAVIDSON RPH

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	03325743	OH
2	183500000X	Pharmacist	0020276	CO

General Provider Information

NPI Number	:	1316357452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA DAVIDSON RPH

Provider Business Mailing Address
First Line	:	1486 OAKLAND PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3507
Country	:	US
Telephone Number	:	614-262-8719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1486 OAKLAND PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3507
Country	:	US
Telephone Number	:	614-262-8719
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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