Provider Demographics
NPI:1558678805
Name:DAVIS, DAVID ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALBERT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 HILO ST
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3550
Mailing Address - Country:US
Mailing Address - Phone:985-634-0336
Mailing Address - Fax:
Practice Address - Street 1:348 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2672
Practice Address - Country:US
Practice Address - Phone:228-467-4436
Practice Address - Fax:228-467-4188
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist