Ken Searcy Davidson, RPH
Individual provider Active NPI Pharmacist · Highland, AR
NPI 1104414523 · NPPES record last updated Jan 3, 2021
Key facts
- NPI
- 1104414523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD07731 (AR)
- Practice address
- 1238A Highway 62 412
Highland, AR 72542-9468 - Phone
- (870) 955-1022
- Fax
- (870) 955-5052
- NPI assigned
- Jan 3, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD07731 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davidson Drug, LLC | Current |
Accepting new patients |
Locations
1238A Highway 62 412
Highland, AR 72542
Phone (870) 955-1022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD07731 | AR | Yes |
Addresses
Primary practice location
1238A Highway 62 412
Highland, AR 72542-9468
Mailing address
1238A Highway 62 412
Highland, AR 72542-9468
Phone (870) 955-1022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 236370407 | Medicaid | AR |
Other providers in Highland, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.