Provider Demographics
NPI:1679175012
Name:DAVIS, JAMIE LYN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LUSK DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2028
Mailing Address - Country:US
Mailing Address - Phone:417-451-1177
Mailing Address - Fax:
Practice Address - Street 1:3200 LUSK DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2028
Practice Address - Country:US
Practice Address - Phone:417-451-1177
Practice Address - Fax:417-451-9620
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014033314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist