Provider Demographics
NPI:1578946927
Name:DAVIS, CORTNI (RPH, PHARM D)
Entity Type:Individual
Prefix:
First Name:CORTNI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 GOLD NUGGET
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8802
Mailing Address - Country:US
Mailing Address - Phone:864-561-5930
Mailing Address - Fax:
Practice Address - Street 1:1993 DICKERSON BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2795
Practice Address - Country:US
Practice Address - Phone:704-296-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist