Provider Demographics
NPI:1689354003
Name:DAVIS, LIBERTY ANN (RPH)
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:ANN
Last Name:DAVIS
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 1:1732 WASHINGTON ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5564
Mailing Address - Country:US
Mailing Address - Phone:208-733-1166
Mailing Address - Fax:208-733-1963
Practice Address - Street 1:1732 WASHINGTON ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5564
Practice Address - Country:US
Practice Address - Phone:208-733-1166
Practice Address - Fax:208-733-1963
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist