Provider Demographics
NPI:1497086011
Name:DAVIS, REBECCA S (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:WOOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1925 E ANDY DEVINE AVE
Mailing Address - Street 2:WALGREENS
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-7101
Mailing Address - Country:US
Mailing Address - Phone:928-753-7766
Mailing Address - Fax:
Practice Address - Street 1:1925 E ANDY DEVINE AVE
Practice Address - Street 2:WALGREENS
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-7101
Practice Address - Country:US
Practice Address - Phone:928-753-7766
Practice Address - Fax:928-753-7786
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist