Provider Demographics
NPI:1275294092
Name:DAVENPORT, KATHERINE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
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 1:501 S WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-8120
Mailing Address - Country:US
Mailing Address - Phone:928-649-1532
Mailing Address - Fax:928-634-5655
Practice Address - Street 1:501 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-8120
Practice Address - Country:US
Practice Address - Phone:928-649-1532
Practice Address - Fax:928-634-5655
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21102-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist