MEDICARE: TAMMY WALKER DAVISON 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	4937	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4937	OTHER	WV	PHARMACIST LICENSE NUMBER
2	12015	OTHER	MD	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1346228293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY WALKER DAVISON RPH

Provider Business Mailing Address
First Line	:	5600 COLD RUN VALLEY RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-4952
Country	:	US
Telephone Number	:	304-258-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 BERKMORE PL
Second Line	:	SUITE 1C
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-6247
Country	:	US
Telephone Number	:	304-258-3800
Fax Number	:	304-258-2670

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

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	07/08/2007

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