Provider Demographics
NPI:1790090942
Name:DAVIS, ELLEN KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61162 TIMBERBEND DR
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-2950
Mailing Address - Country:US
Mailing Address - Phone:985-882-7498
Mailing Address - Fax:985-882-7498
Practice Address - Street 1:1260 FRONT ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2054
Practice Address - Country:US
Practice Address - Phone:985-641-5557
Practice Address - Fax:985-646-0646
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist