Provider Demographics
NPI:1740560879
Name:DAVIDOWITZ, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DAVIDOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7262
Mailing Address - Country:US
Mailing Address - Phone:704-867-2474
Mailing Address - Fax:704-867-7746
Practice Address - Street 1:2500 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-7262
Practice Address - Country:US
Practice Address - Phone:704-867-2474
Practice Address - Fax:704-867-7746
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22097183500000X
SC13508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist