Provider Demographics
NPI:1598840928
Name:DAVIS, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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 1:108 SW MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8667
Mailing Address - Country:US
Mailing Address - Phone:541-737-3491
Mailing Address - Fax:541-737-7616
Practice Address - Street 1:108 SW MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8667
Practice Address - Country:US
Practice Address - Phone:541-737-3491
Practice Address - Fax:541-737-7616
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010403183500000X
GA021731183500000X
WAPH00069785183500000X
OR104131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist