Provider Demographics
NPI:1043351547
Name:DAVIS, JOSEPH TAD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TAD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 E COLONIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5245
Mailing Address - Country:US
Mailing Address - Phone:407-898-4427
Mailing Address - Fax:407-898-6833
Practice Address - Street 1:3901 E COLONIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5245
Practice Address - Country:US
Practice Address - Phone:407-898-4427
Practice Address - Fax:407-898-6833
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS33412OtherPHARMACIST LICENSE