Basic Information
| Provider Information | |||||||||
| NPI: | 1598840928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 SW MEMORIAL PL | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973318667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417373491 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 SW MEMORIAL PL | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973318667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417373491 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0010403 | OR | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 021731 | GA | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH00069785 | WA | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 10413 | OR | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.