Provider Demographics
NPI:1861567521
Name:DAVIS, JEANINE MONIQUE (PHARM D)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:MONIQUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-6563
Mailing Address - Country:US
Mailing Address - Phone:504-469-5967
Mailing Address - Fax:
Practice Address - Street 1:2136 12TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-6563
Practice Address - Country:US
Practice Address - Phone:504-469-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist