Provider Demographics
NPI:1922692656
Name:DAVIS, RENEE CHRISTINE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CHRISTINE
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 1:538 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-2904
Mailing Address - Country:US
Mailing Address - Phone:209-627-5921
Mailing Address - Fax:209-221-4622
Practice Address - Street 1:2800 NAGLEE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7307
Practice Address - Country:US
Practice Address - Phone:209-833-0072
Practice Address - Fax:209-221-4622
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55898183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician