Provider Demographics
NPI:1528416807
Name:DAVIS DRUGS, LLC
Entity Type:Organization
Organization Name:DAVIS DRUGS, LLC
Other - Org Name:DAVIS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-762-3287
Mailing Address - Street 1:300 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-1442
Mailing Address - Country:US
Mailing Address - Phone:765-762-3287
Mailing Address - Fax:765-762-0021
Practice Address - Street 1:300 S PERRY ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-1442
Practice Address - Country:US
Practice Address - Phone:765-762-3287
Practice Address - Fax:765-762-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60006316A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201111490AMedicaid
2160332OtherPK
6782310001Medicare NSC