Provider Demographics
NPI:1477905107
Name:DAVIS, NIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:DAVIS
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 1:411 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4233
Mailing Address - Country:US
Mailing Address - Phone:434-792-8281
Mailing Address - Fax:434-792-3235
Practice Address - Street 1:411 PARK AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4233
Practice Address - Country:US
Practice Address - Phone:434-792-8281
Practice Address - Fax:434-792-3235
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24189183500000X
VA0202214901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist