Provider Demographics
NPI:1215364617
Name:DAVIS, MITCHELL GIVEN (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:GIVEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 KLEE PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7617
Mailing Address - Country:US
Mailing Address - Phone:530-753-9256
Mailing Address - Fax:
Practice Address - Street 1:2002 KLEE PL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7617
Practice Address - Country:US
Practice Address - Phone:530-753-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist