Provider Demographics
NPI:1104415512
Name:DAVIS, CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576-0247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:329A N US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576-8309
Practice Address - Country:US
Practice Address - Phone:620-377-5633
Practice Address - Fax:620-377-5656
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist