Provider Demographics
NPI:1073041000
Name:DAVIS, ANN DEFREESE (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:DEFREESE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5154
Mailing Address - Country:US
Mailing Address - Phone:205-668-1589
Mailing Address - Fax:205-668-2352
Practice Address - Street 1:5100 HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-5154
Practice Address - Country:US
Practice Address - Phone:205-668-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist