Provider Demographics
NPI:1154682573
Name:DAVIS, KEITH PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:PHILLIP
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SE CAUSEY AVE APT S202
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8595
Mailing Address - Country:US
Mailing Address - Phone:503-353-2517
Mailing Address - Fax:
Practice Address - Street 1:8640 SE CAUSEY AVE APT S202
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8595
Practice Address - Country:US
Practice Address - Phone:503-353-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist