MEDICARE: MR. GLENN RICHARD 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	33747	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639353113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN RICHARD DAVIS

Provider Business Mailing Address
First Line	:	985 RIDGE RD
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2905
Country	:	US
Telephone Number	:	585-872-1380
Fax Number	:	585-872-1398

Provider Business Practice Location Address
First Line	:	985 RIDGE RD
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2905
Country	:	US
Telephone Number	:	585-872-1380
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	02/19/2010

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Directions to “ MR. GLENN RICHARD DAVIS ” Practice Location

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