MEDICARE: COLLETTE M DAVIS

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	5302025462	MI

General Provider Information

NPI Number	:	1487305959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLETTE M DAVIS

Provider Business Mailing Address
First Line	:	45 COLUMBIA AVE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-3703
Country	:	US
Telephone Number	:	269-965-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 COLUMBIA AVE E
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-3703
Country	:	US
Telephone Number	:	269-965-5631
Fax Number	:	269-965-3478

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

Provider Enumeration Date	:	01/15/2022
Last Update Date	:	01/15/2022

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Directions to “ COLLETTE M DAVIS ” Practice Location

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