Provider Demographics
NPI:1982036059
Name:DAVIES, MARIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYNN
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-469-8456
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2076
Practice Address - Country:US
Practice Address - Phone:909-469-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22438183500000X
CA71563183500000X
PARP448055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist