Provider Demographics
NPI:1679022099
Name:DAVIS, CHRISTOPHER TORY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TORY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 TALL PINES DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2869
Mailing Address - Country:US
Mailing Address - Phone:404-394-1975
Mailing Address - Fax:
Practice Address - Street 1:4125 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1836
Practice Address - Country:US
Practice Address - Phone:678-945-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist