Provider Demographics
NPI:1851035018
Name:DAVIS, CHELSEA L
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72567-0042
Mailing Address - Country:US
Mailing Address - Phone:870-834-3500
Mailing Address - Fax:
Practice Address - Street 1:1243 HIGHWAY 62 412
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:AR
Practice Address - Zip Code:72542-9469
Practice Address - Country:US
Practice Address - Phone:870-856-3080
Practice Address - Fax:870-856-4165
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist