Provider Demographics
NPI:1831479484
Name:DAVIS, WILLIAM J (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1310
Mailing Address - Country:US
Mailing Address - Phone:954-390-0444
Mailing Address - Fax:
Practice Address - Street 1:2540 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1310
Practice Address - Country:US
Practice Address - Phone:954-390-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23408183500000X
KY9539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist