Provider Demographics
NPI:1508340001
Name:DAVIS, DOROTHY ANN SHELTON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ANN SHELTON
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 1:4001 LEGACY LOOP
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4686
Mailing Address - Country:US
Mailing Address - Phone:318-471-2016
Mailing Address - Fax:
Practice Address - Street 1:19479 HIGHWAY 167
Practice Address - Street 2:
Practice Address - City:BENTLEY
Practice Address - State:LA
Practice Address - Zip Code:71407-3502
Practice Address - Country:US
Practice Address - Phone:318-899-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.020742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist