Provider Demographics
NPI:1497184543
Name:DAVIS, DANIELLA (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10855 S US HIGHWAY 1
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6410
Mailing Address - Country:US
Mailing Address - Phone:772-335-1557
Mailing Address - Fax:772-335-1559
Practice Address - Street 1:10855 S US HIGHWAY 1
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6410
Practice Address - Country:US
Practice Address - Phone:772-335-1557
Practice Address - Fax:772-335-1559
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41053183500000X
MAPH25832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist