Active NPI
Larry V Davison, R. PH.
- Pharmacist
- Clinton, MO
National Provider Identifier
1104034446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28369
- Practice address
- 1600 N 2ND St
Clinton, MO 64735-1192 - Phone
- (660) 885-5511
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28369 | MO | Primary |
| Pharmacist | 183500000X | 09115 | KS |
Addresses
Primary practice location
1600 N 2ND St
Clinton, MO 64735-1192
Mailing address
800 W Jefferson St
Clinton, MO 64735-1939
Phone (660) 885-5511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09115 | KS | MD | Pharmacist |
| 28369 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104034446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 W JEFFERSON ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351939",
"telephone_number": "660-885-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 N 2ND ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647351192",
"telephone_number": "660-885-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "LARRY",
"middle_name": "V",
"name_prefix": "Mr.",
"credential": "R. PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "28369",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KS",
"license": "09115",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.