Provider Demographics
NPI:1306182720
Name:G. L. DAVIS DRUG INC
Entity Type:Organization
Organization Name:G. L. DAVIS DRUG INC
Other - Org Name:DAVIS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIS IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-305-5099
Mailing Address - Street 1:109 WEST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-1359
Mailing Address - Country:US
Mailing Address - Phone:740-305-5099
Mailing Address - Fax:740-305-5099
Practice Address - Street 1:109 WEST ST
Practice Address - Street 2:SUITE A
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1359
Practice Address - Country:US
Practice Address - Phone:740-305-5099
Practice Address - Fax:740-305-5099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G. L. DAVIS DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022242050332B00000X, 3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy