Provider Demographics
NPI:1053525691
Name:DAVIES, WENDE B (RPH)
Entity type:Individual
Prefix:MRS
First Name:WENDE
Middle Name:B
Last Name:DAVIES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1428
Mailing Address - Country:US
Mailing Address - Phone:352-383-2551
Mailing Address - Fax:
Practice Address - Street 1:1565 US HWY 441 N
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:407-880-6493
Practice Address - Fax:407-880-8414
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0022377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist