Provider Demographics
NPI:1457511446
Name:DAVENPORT, MANDY CONNER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:CONNER
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 NORTHSIDE DR W
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5378
Mailing Address - Country:US
Mailing Address - Phone:912-764-8241
Mailing Address - Fax:912-489-4818
Practice Address - Street 1:603 NORTHSIDE DR W
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5378
Practice Address - Country:US
Practice Address - Phone:912-764-8241
Practice Address - Fax:912-489-4818
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist