Provider Demographics
NPI:1265531164
Name:DAVISON DRUG & STATIONERY
Entity type:Organization
Organization Name:DAVISON DRUG & STATIONERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:PETESCH
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D RPH
Authorized Official - Phone:530-458-2188
Mailing Address - Street 1:640 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2441
Mailing Address - Country:US
Mailing Address - Phone:530-458-2188
Mailing Address - Fax:530-458-7780
Practice Address - Street 1:640 MARKET STREET
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2441
Practice Address - Country:US
Practice Address - Phone:530-458-2188
Practice Address - Fax:530-458-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY470443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA470440Medicaid
CAPHA470440Medicaid