Provider Demographics
NPI:1700169174
Name:DAVIS, JANICE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 DOERUN CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1657
Mailing Address - Country:US
Mailing Address - Phone:770-242-7561
Mailing Address - Fax:
Practice Address - Street 1:4330 DOERUN CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1657
Practice Address - Country:US
Practice Address - Phone:770-242-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07473183500000X
FLPS21295183500000X
GARPH016032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist