MEDICARE: MRS. JILL ALYSSA DAVIES R.PH

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	RP042102R	PA

General Provider Information

NPI Number	:	1568762623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL ALYSSA DAVIES R.PH

Provider Business Mailing Address
First Line	:	167 SUMMIT DR
Second Line	:
City	:	COLMAR
State	:	PA
Zip	:	18915-9707
Country	:	US
Telephone Number	:	215-997-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 S MAIN ST
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2832
Country	:	US
Telephone Number	:	215-699-7555
Fax Number	:	215-699-6792

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

Provider Enumeration Date	:	10/23/2010
Last Update Date	:	10/23/2010

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