Provider Demographics
NPI:1679898340
Name:DAVIS, STEVEN WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PICNIC LN
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9352
Mailing Address - Country:US
Mailing Address - Phone:570-743-0182
Mailing Address - Fax:
Practice Address - Street 1:1000 N SUSQUEHANNA TRAIL
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876
Practice Address - Country:US
Practice Address - Phone:570-743-0113
Practice Address - Fax:570-788-4201
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027535L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist