Provider Demographics
NPI:1982120960
Name:DAVENPORT, CHRISTINA SUZANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:SUZANNE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:PO BOX 2574
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-0045
Mailing Address - Country:US
Mailing Address - Phone:706-455-2288
Mailing Address - Fax:
Practice Address - Street 1:4075 E FIRST ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4526
Practice Address - Country:US
Practice Address - Phone:706-455-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist