Provider Demographics
NPI:1053324012
Name:DAVIS-BROWN, AVIS LEVETHIA (RPH,MBA)
Entity type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:LEVETHIA
Last Name:DAVIS-BROWN
Suffix:
Gender:F
Credentials:RPH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 S 30TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7154
Mailing Address - Country:US
Mailing Address - Phone:708-829-8104
Mailing Address - Fax:708-358-6639
Practice Address - Street 1:2200 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7831
Practice Address - Country:US
Practice Address - Phone:928-537-6321
Practice Address - Fax:928-537-7814
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist