1245520923 NPI number — DR. MIRANDA BETH WHITSETT DAVIS PHARMD.

Table of content: DR. MIRANDA BETH WHITSETT DAVIS PHARMD. (NPI 1245520923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245520923 NPI number — DR. MIRANDA BETH WHITSETT DAVIS PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
MIRANDA
Provider Middle Name:
BETH WHITSETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD.
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:
1245520923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 MEADOW RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35652-6354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-247-3191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16100 HIGHWAY 72
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35652-8119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-247-6830
Provider Business Practice Location Address Fax Number:
256-247-6833
Provider Enumeration Date:
04/14/2011

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:  15498 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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