Provider Demographics
NPI:1932570660
Name:DAVIS, ALICIA M (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
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 1:1400 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3021
Mailing Address - Country:US
Mailing Address - Phone:609-323-7503
Mailing Address - Fax:609-323-7508
Practice Address - Street 1:1400 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3021
Practice Address - Country:US
Practice Address - Phone:609-323-7503
Practice Address - Fax:609-323-7508
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03726000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist