Provider Demographics
NPI:1679099006
Name:DAVIS, CASSANDRA DESHAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:DESHAWN
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 1:3351 N CHATHAM RD APT J
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2795
Mailing Address - Country:US
Mailing Address - Phone:301-785-5054
Mailing Address - Fax:
Practice Address - Street 1:7172 COLUMBIA GATEWAY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2990
Practice Address - Country:US
Practice Address - Phone:888-662-6779
Practice Address - Fax:877-800-4790
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist