Provider Demographics
NPI:1003241597
Name:DAVIS, ADELE C G (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:C G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:C
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 35935
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-5935
Mailing Address - Country:US
Mailing Address - Phone:575-491-0332
Mailing Address - Fax:
Practice Address - Street 1:1200 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-463-4031
Practice Address - Fax:907-463-6658
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist