MEDICARE: BETH ANN DAVENPORT 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	PD11290	AR

General Provider Information

NPI Number	:	1356635460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN DAVENPORT PHARM.D.

Provider Business Mailing Address
First Line	:	2509 MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7606
Country	:	US
Telephone Number	:	501-758-9307
Fax Number	:	501-758-9308

Provider Business Practice Location Address
First Line	:	2509 MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7606
Country	:	US
Telephone Number	:	501-758-9307
Fax Number	:	501-758-9308

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

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/07/2013

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