Provider Demographics
NPI:1316222649
Name:DAVIS, JEFF CORY (RPH)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:CORY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6124
Mailing Address - Country:US
Mailing Address - Phone:928-343-2311
Mailing Address - Fax:928-343-2325
Practice Address - Street 1:2378 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6124
Practice Address - Country:US
Practice Address - Phone:928-343-2311
Practice Address - Fax:928-343-2325
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS07895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2207OtherIMMUNIZER LICENSE