Provider Demographics
NPI:1053697631
Name:DAVIS, EDWIN CLYDE III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:CLYDE
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3209
Mailing Address - Country:US
Mailing Address - Phone:615-449-4330
Mailing Address - Fax:
Practice Address - Street 1:1303 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3209
Practice Address - Country:US
Practice Address - Phone:615-449-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist