Provider Demographics
NPI:1346437829
Name:DAVIS, MICHAEL EDWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWIN
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 1:624 HAWTHORNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803
Mailing Address - Country:US
Mailing Address - Phone:865-983-5566
Mailing Address - Fax:865-983-5566
Practice Address - Street 1:624 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6316
Practice Address - Country:US
Practice Address - Phone:865-983-5566
Practice Address - Fax:865-983-5566
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist