MEDICARE: CANDY 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	16185	NV

General Provider Information

NPI Number	:	1770869661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDY DAVIS

Provider Business Mailing Address
First Line	:	2400 E TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5441
Country	:	US
Telephone Number	:	702-435-6289
Fax Number	:	702-435-6375

Provider Business Practice Location Address
First Line	:	2400 E TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5441
Country	:	US
Telephone Number	:	702-435-6289
Fax Number	:	702-435-6375

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

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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Directions to “ CANDY DAVIS ” Practice Location

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