Provider Demographics
NPI:1891071528
Name:DAVLIN, DAVID SEAN (BS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SEAN
Last Name:DAVLIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 67TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1101
Mailing Address - Country:US
Mailing Address - Phone:402-201-5978
Mailing Address - Fax:
Practice Address - Street 1:5038 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3111
Practice Address - Country:US
Practice Address - Phone:402-551-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist