Provider Demographics
NPI:1396970695
Name:DAVIS, DANIELLE R (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
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 1:27 VERONICA LN
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4150
Mailing Address - Country:US
Mailing Address - Phone:304-283-1567
Mailing Address - Fax:
Practice Address - Street 1:96 PATRICK HENRY WAY
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4391
Practice Address - Country:US
Practice Address - Phone:304-728-2190
Practice Address - Fax:304-728-9063
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRPH 0006497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist