Provider Demographics
NPI:1326475658
Name:DAVIS, JUSTIN HOWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:HOWARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 OLD FERRY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7832
Mailing Address - Country:US
Mailing Address - Phone:843-412-1588
Mailing Address - Fax:
Practice Address - Street 1:1810 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3309
Practice Address - Country:US
Practice Address - Phone:843-388-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist