Provider Demographics
NPI:1740885227
Name:DAVIS, JOSEPH L (PD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8318
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8318
Mailing Address - Country:US
Mailing Address - Phone:501-268-9400
Mailing Address - Fax:501-268-9405
Practice Address - Street 1:2412 E RACE AVE STE F
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4780
Practice Address - Country:US
Practice Address - Phone:501-268-9400
Practice Address - Fax:501-268-9405
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty