Provider Demographics
NPI:1801220363
Name:DAVIS, GARY JAMES (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2646
Mailing Address - Country:US
Mailing Address - Phone:859-331-0370
Mailing Address - Fax:859-331-9728
Practice Address - Street 1:1825 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2646
Practice Address - Country:US
Practice Address - Phone:859-331-0370
Practice Address - Fax:859-331-9728
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232600183500000X
KY016735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist