Provider Demographics
NPI:1194018077
Name:DAVIS, NICHOLAS OLIVER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:OLIVER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 WESTRANCH PL
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-8337
Mailing Address - Country:US
Mailing Address - Phone:805-358-2918
Mailing Address - Fax:
Practice Address - Street 1:209 W VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8359
Practice Address - Country:US
Practice Address - Phone:805-383-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist