Provider Demographics
NPI:1992839138
Name:DAVIES, ROBERT E (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DAVIES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BURD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2115
Mailing Address - Country:US
Mailing Address - Phone:330-832-6477
Mailing Address - Fax:
Practice Address - Street 1:2208 LINCOLN WAY NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6144
Practice Address - Country:US
Practice Address - Phone:220-833-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-07224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist