Provider Demographics
NPI:1740811488
Name:DAVIS, JOHN LESLIE (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LESLIE
Last Name:DAVIS
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 1:5208 ELLEN JAYNE WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1613
Mailing Address - Country:US
Mailing Address - Phone:432-638-7276
Mailing Address - Fax:432-694-0558
Practice Address - Street 1:5208 ELLEN JAYNE WAY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-1613
Practice Address - Country:US
Practice Address - Phone:432-638-7276
Practice Address - Fax:432-694-0558
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist