Provider Demographics
NPI:1780922799
Name:DAVIS, ROBERT A (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042
Mailing Address - Country:US
Mailing Address - Phone:478-998-4198
Mailing Address - Fax:
Practice Address - Street 1:500 INDUSTRIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-998-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA203301835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric