Provider Demographics
NPI:1548586811
Name:DAVIS, ARCHIE BROOKS (RPH)
Entity type:Individual
Prefix:
First Name:ARCHIE
Middle Name:BROOKS
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 1:310 S MAIN ST
Mailing Address - Street 2:P.O. BOX 480999
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-1726
Mailing Address - Country:US
Mailing Address - Phone:334-295-4270
Mailing Address - Fax:334-295-0141
Practice Address - Street 1:310 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-1726
Practice Address - Country:US
Practice Address - Phone:334-295-4270
Practice Address - Fax:334-295-0141
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist