Provider Demographics
NPI:1811468952
Name:DAVIDSON PHARMACY, LLC
Entity type:Organization
Organization Name:DAVIDSON PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:DAVIDSON
Authorized Official - Last Name:NULL
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:662-728-4401
Mailing Address - Street 1:203A N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2701
Mailing Address - Country:US
Mailing Address - Phone:662-728-4401
Mailing Address - Fax:662-728-9659
Practice Address - Street 1:203A N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2701
Practice Address - Country:US
Practice Address - Phone:662-728-4401
Practice Address - Fax:662-728-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy