Provider Demographics
NPI:1770942047
Name:DAVIDSON, JILL (PHARM D)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SHADELAND STA
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3957
Mailing Address - Country:US
Mailing Address - Phone:317-887-7577
Mailing Address - Fax:
Practice Address - Street 1:7910 E WASHINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6803
Practice Address - Country:US
Practice Address - Phone:317-887-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020219A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist