Provider Demographics
NPI:1144206046
Name:DAVIS, GWYNDOLYN ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:GWYNDOLYN
Middle Name:ANN
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 1:12073 RENTON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3728
Mailing Address - Country:US
Mailing Address - Phone:206-931-7992
Mailing Address - Fax:
Practice Address - Street 1:14277 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4124
Practice Address - Country:US
Practice Address - Phone:206-431-9652
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP15363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist