Provider Demographics
NPI:1356968291
Name:DAVIS, KRISTY (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12612 FOREST OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-6682
Mailing Address - Country:US
Mailing Address - Phone:405-306-7490
Mailing Address - Fax:
Practice Address - Street 1:112 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3197
Practice Address - Country:US
Practice Address - Phone:405-282-2700
Practice Address - Fax:405-282-4715
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59238183500000X
CA63855183500000X
OK13818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist