Provider Demographics
NPI:1245520923
Name:DAVIS, MIRANDA BETH WHITSETT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:BETH WHITSETT
Last Name:DAVIS
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 1:139 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-6354
Mailing Address - Country:US
Mailing Address - Phone:256-247-3191
Mailing Address - Fax:
Practice Address - Street 1:16100 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8119
Practice Address - Country:US
Practice Address - Phone:256-247-6830
Practice Address - Fax:256-247-6833
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist