Active NPI
Samuel Mark Davis, PHARMACIST
- Pharmacist
- Bettendorf, IA
National Provider Identifier
1497027171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14533
- Practice address
- 3425 Middle Rd
Bettendorf, IA 52722-3404 - Phone
- (563) 332-6049
- Fax
- (563) 332-6162
- NPI assigned
- Jan 27, 2012
- 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 | 14533 | IA | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 14533 | IA |
Addresses
Primary practice location
3425 Middle Rd
Bettendorf, IA 52722-3404
Mailing address
3425 Middle Rd
Bettendorf, IA 52722-3404
Phone (563) 332-6049
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14533 | Other | IA | IOWA BOARD OF PHARMACY |
| 051.031876 | Other | IL | DEPT OF PROFESSIONAL REGULATION |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14533 | IA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327622400000",
"number": "1497027171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3425 MIDDLE RD",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527223404",
"telephone_number": "563-332-6049",
"fax_number": "563-332-6162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3425 MIDDLE RD",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527223404",
"telephone_number": "563-332-6049",
"fax_number": "563-332-6162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SAMUEL",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-27",
"last_updated": "2012-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "14533",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IA",
"license": "14533",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA BOARD OF PHARMACY",
"identifier": "14533",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF PROFESSIONAL REGULATION",
"identifier": "051.031876",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.