Provider Demographics
NPI:1063708261
Name:NORRIS, DAVENA MARIE (PHARMD, RPH, PHC)
Entity type:Individual
Prefix:DR
First Name:DAVENA
Middle Name:MARIE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PHARMD, RPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W. HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-5141
Mailing Address - Country:US
Mailing Address - Phone:575-636-7326
Mailing Address - Fax:575-521-5376
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5141
Practice Address - Country:US
Practice Address - Phone:575-521-5370
Practice Address - Fax:575-521-5376
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00007834183500000X
NMIN00003099390200000X
NMPC000002371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program