Individual
MR. JERRY WESLEY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
228 MAIN ST, ORDWAY, CO 81063-1403
(719) 267-3544
(719) 267-4443
Mailing address
106 E 7TH ST, ORDWAY, CO 81063-1021
(719) 267-3884
(719) 267-4443
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10634
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10634
PHARMACY LICENSE
CO
Enumeration date
08/14/2006
Last updated
07/08/2007
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