Provider Demographics
NPI:1215581103
Name:DAVIS, NANCY SALLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SALLA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NORTHWESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-6816
Mailing Address - Country:US
Mailing Address - Phone:765-714-2799
Mailing Address - Fax:
Practice Address - Street 1:2801 NORTHWESTERN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-6816
Practice Address - Country:US
Practice Address - Phone:765-714-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014595A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty