Provider Demographics
NPI:1407905102
Name:DAVENPORT, PAUL DWIGHT (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DWIGHT
Last Name:DAVENPORT
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 1:2942 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3445
Mailing Address - Country:US
Mailing Address - Phone:325-696-6465
Mailing Address - Fax:325-696-3359
Practice Address - Street 1:697 HOSPITAL RD
Practice Address - Street 2:7 MDSS SGSAP
Practice Address - City:DYESS AFB
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:325-696-6465
Practice Address - Fax:325-696-3359
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist