Provider Demographics
NPI:1699080036
Name:DAVIS, PAULA S (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1001
Mailing Address - Country:US
Mailing Address - Phone:918-683-0135
Mailing Address - Fax:847-396-3002
Practice Address - Street 1:4 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1001
Practice Address - Country:US
Practice Address - Phone:918-683-0135
Practice Address - Fax:918-683-8596
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist