Provider Demographics
NPI:1386034064
Name:DAVIS, STEPHANIE (CPHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1524
Mailing Address - Country:US
Mailing Address - Phone:513-474-6367
Mailing Address - Fax:513-766-8155
Practice Address - Street 1:4476 FOREST TRL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1524
Practice Address - Country:US
Practice Address - Phone:513-474-6367
Practice Address - Fax:513-766-8155
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH540107010169066183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician