Organization
RANDALL SCOTT DAVIS
Active
Other names
Shoreline Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL SCOTT DAVIS (OWNER)
(269) 637-9476
Entity
Organization
Contact information
Practice address
901 S BAILEY AVE STE 3, SOUTH HAVEN, MI 49090-6745
(269) 637-9476
(269) 639-1650
Mailing address
901 S BAILEY AVE STE 3, SOUTH HAVEN, MI 49090-6745
(269) 637-9476
(269) 639-1650
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5302025949
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2726327
—
MI
Enumeration date
05/11/2006
Last updated
02/28/2017
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