Provider Demographics
NPI:1801907381
Name:DAVENPORT, DEBORAH J (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 LOGAN LN
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2806
Mailing Address - Country:US
Mailing Address - Phone:330-487-1535
Mailing Address - Fax:
Practice Address - Street 1:19999 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2074
Practice Address - Country:US
Practice Address - Phone:440-439-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-15735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist