Provider Demographics
NPI:1295209864
Name:DAVIS, REID NICOLE (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:REID
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
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 1:1388 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32464-8013
Mailing Address - Country:US
Mailing Address - Phone:850-333-4119
Mailing Address - Fax:
Practice Address - Street 1:1537 S US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2800
Practice Address - Country:US
Practice Address - Phone:334-774-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20683183500000X
FL58256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist