1578849881 NPI number — MR. THOMAS MERRICK DAVIS R.PH.

Table of content: MR. THOMAS MERRICK DAVIS R.PH. (NPI 1578849881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578849881 NPI number — MR. THOMAS MERRICK DAVIS R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
THOMAS
Provider Middle Name:
MERRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
RICK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578849881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-7042
Provider Business Mailing Address Fax Number:
928-674-7463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX PH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-7042
Provider Business Practice Location Address Fax Number:
928-674-7463
Provider Enumeration Date:
11/01/2011

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:  25854 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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