Provider Demographics
NPI:1710260070
Name:DAVENPORT, DIANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DAVENPORT
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 1:20500 FM 529 RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3296
Mailing Address - Country:US
Mailing Address - Phone:281-859-2106
Mailing Address - Fax:
Practice Address - Street 1:20500 FM 529 RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3296
Practice Address - Country:US
Practice Address - Phone:281-859-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist