1346228293 NPI number — TAMMY WALKER DAVISON RPH

Table of content: TAMMY WALKER DAVISON RPH (NPI 1346228293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346228293 NPI number — TAMMY WALKER DAVISON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVISON
Provider First Name:
TAMMY
Provider Middle Name:
WALKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346228293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 COLD RUN VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25411-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-258-9021
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 BERKMORE PL
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
BERKELEY SPRINGS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25411-6247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-258-3800
Provider Business Practice Location Address Fax Number:
304-258-2670
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  4937 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4937 . This is a "PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 12015 . This is a "PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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