1568452118 NPI number — SUSANNE T DAVIS RPH

Table of content: SUSANNE T DAVIS RPH (NPI 1568452118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568452118 NPI number — SUSANNE T DAVIS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
SUSANNE
Provider Middle Name:
T
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:
1568452118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK GROVE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71263-7766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-418-0769
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 DEPOT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELHI
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71232-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-878-2261
Provider Business Practice Location Address Fax Number:
318-878-9870
Provider Enumeration Date:
10/25/2005

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:  15204 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1275271 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1911090 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com