Individual
MR. SAMUEL MARK DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
3425 MIDDLE RD, BETTENDORF, IA 52722-3404
(563) 332-6049
(563) 332-6162
Mailing address
3425 MIDDLE RD, BETTENDORF, IA 52722-3404
(563) 332-6049
(563) 332-6162
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14533
IA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
14533
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051.031876
DEPT OF PROFESSIONAL REGULATION
IL
01
—
14533
IOWA BOARD OF PHARMACY
IA
Enumeration date
01/27/2012
Last updated
01/27/2012
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