Provider Demographics
NPI:1134489701
Name:KAVANAUGH-DAVIS, BRENDA MAUREEN
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MAUREEN
Last Name:KAVANAUGH-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:K
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:601 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6604
Mailing Address - Country:US
Mailing Address - Phone:301-203-4451
Mailing Address - Fax:
Practice Address - Street 1:601 CEDAR RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6604
Practice Address - Country:US
Practice Address - Phone:301-203-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108781835P0018X
LA115821835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy