Provider Demographics
NPI:1225204811
Name:DAVENPORT, ANNA C (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:DAVENPORT
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 1:2500 E LAKE ST
Mailing Address - Street 2:T-0052
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1909
Mailing Address - Country:US
Mailing Address - Phone:612-203-2487
Mailing Address - Fax:
Practice Address - Street 1:2500 E LAKE ST
Practice Address - Street 2:T-0052
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1909
Practice Address - Country:US
Practice Address - Phone:651-704-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist