Provider Demographics
NPI:1962926600
Name:DAVIDSON, PAUL MERRILL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MERRILL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8807
Mailing Address - Country:US
Mailing Address - Phone:541-902-7333
Mailing Address - Fax:541-902-7327
Practice Address - Street 1:4701 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8807
Practice Address - Country:US
Practice Address - Phone:541-902-7333
Practice Address - Fax:541-902-7327
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist