Provider Demographics
NPI:1265770630
Name:DAVIS, CAROLINA MARIA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MARIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11255 CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2903
Mailing Address - Country:US
Mailing Address - Phone:813-655-1685
Mailing Address - Fax:
Practice Address - Street 1:11255 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2903
Practice Address - Country:US
Practice Address - Phone:813-655-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist