Provider Demographics
NPI:1104074939
Name:DAVIS, SHAQUAN NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAQUAN
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MCFARLAND BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5802
Mailing Address - Country:US
Mailing Address - Phone:205-345-2660
Mailing Address - Fax:
Practice Address - Street 1:2306 MCFARLAND BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5802
Practice Address - Country:US
Practice Address - Phone:205-345-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist