MEDICARE: MR. JAMES ROBERT DAVILA 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	40699	MO

General Provider Information

NPI Number	:	1750583720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ROBERT DAVILA RPH

Provider Business Mailing Address
First Line	:	1112 SHADOWFAIRE CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7487
Country	:	US
Telephone Number	:	636-391-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	13900 RIVERPORT DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4804
Country	:	US
Telephone Number	:	180-033-2545
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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