Provider Demographics
NPI:1952627887
Name:DAVIS, HEIDY ALENE (RPH)
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:ALENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WALKER WAY
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4963
Mailing Address - Country:US
Mailing Address - Phone:518-218-1772
Mailing Address - Fax:518-218-3387
Practice Address - Street 1:25 WALKER WAY
Practice Address - Street 2:SUITE 3A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4963
Practice Address - Country:US
Practice Address - Phone:518-218-1772
Practice Address - Fax:518-218-3387
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050826183500000X
MEPR5223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist