Provider Demographics
NPI:1184906224
Name:DAVIDSON, CISLEY D (PHARMD)
Entity type:Individual
Prefix:
First Name:CISLEY
Middle Name:D
Last Name:DAVIDSON
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 1:806 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2324
Mailing Address - Country:US
Mailing Address - Phone:931-728-0874
Mailing Address - Fax:931-728-7318
Practice Address - Street 1:806 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2324
Practice Address - Country:US
Practice Address - Phone:931-728-0874
Practice Address - Fax:931-728-7318
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist