Provider Demographics
NPI:1215274378
Name:DAVIS, AMELIA MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MICHELLE
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 1:3525 ROSS CLARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-5935
Mailing Address - Country:US
Mailing Address - Phone:334-792-4812
Mailing Address - Fax:334-792-4628
Practice Address - Street 1:3525 ROSS CLARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-5935
Practice Address - Country:US
Practice Address - Phone:334-792-4812
Practice Address - Fax:334-792-4628
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist