MEDICARE: STEVEN LEWIS DAVIS 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	03-1-09076	OH

General Provider Information

NPI Number	:	1992798565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LEWIS DAVIS RPH

Provider Business Mailing Address
First Line	:	1516 MADISON PL
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-7200
Country	:	US
Telephone Number	:	419-738-6674
Fax Number	:	419-738-3019

Provider Business Practice Location Address
First Line	:	1302 DEFIANCE ST
Second Line	:
City	:	WAPAKONETA
State	:	OH
Zip	:	45895-1081
Country	:	US
Telephone Number	:	419-738-5958
Fax Number	:	419-738-3019

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/08/2007

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