Provider Demographics
NPI:1962730739
Name:DAVIS, ANGELIA M
Entity type:Individual
Prefix:MS
First Name:ANGELIA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5654 HORSESHOE FLS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6910
Mailing Address - Country:US
Mailing Address - Phone:281-778-5466
Mailing Address - Fax:
Practice Address - Street 1:3210 HILLCROFT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5806
Practice Address - Country:US
Practice Address - Phone:832-242-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist