Provider Demographics
NPI:1750064226
Name:DAVENPORT, JOCELYN BREANNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:BREANNA
Last Name:DAVENPORT
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 1:110 GERDING DR
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-9601
Mailing Address - Country:US
Mailing Address - Phone:704-777-1908
Mailing Address - Fax:
Practice Address - Street 1:720 E US HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7206
Practice Address - Country:US
Practice Address - Phone:910-582-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist