Provider Demographics
NPI:1750693974
Name:DAVIS, DAVID MAYER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MAYER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:MAYER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:9 OLD PLANTATION WAY
Mailing Address - Street 2:9 OLD PLANATAION WAY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6303
Mailing Address - Country:US
Mailing Address - Phone:410-484-9018
Mailing Address - Fax:
Practice Address - Street 1:6838 LOCH RAVEN BLVD
Practice Address - Street 2:6838 LOCH RAVEN BLVD
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-8301
Practice Address - Country:US
Practice Address - Phone:410-825-8900
Practice Address - Fax:410-825-7145
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist