Provider Demographics
NPI:1619706090
Name:DAVIS, LINDA IVETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:IVETTE
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 1:72027 DINAH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1781
Mailing Address - Country:US
Mailing Address - Phone:760-321-4892
Mailing Address - Fax:
Practice Address - Street 1:72027 DINAH SHORE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1781
Practice Address - Country:US
Practice Address - Phone:760-321-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist