Provider Demographics
NPI:1427146299
Name:DAVENPORT, ROGER A (RPH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3018
Mailing Address - Country:US
Mailing Address - Phone:806-323-6171
Mailing Address - Fax:806-323-6133
Practice Address - Street 1:200 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3018
Practice Address - Country:US
Practice Address - Phone:806-323-6171
Practice Address - Fax:806-323-6133
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist