Provider Demographics
NPI:1578197695
Name:DAVIS, HATTIE LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:HATTIE
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4860
Mailing Address - Country:US
Mailing Address - Phone:713-269-6679
Mailing Address - Fax:
Practice Address - Street 1:6200 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3803
Practice Address - Country:US
Practice Address - Phone:281-208-1741
Practice Address - Fax:281-208-1744
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist