Davison Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Davison, MI
NPI 1720701253 · NPPES record last updated May 9, 2023
Key facts
- NPI
- 1720701253
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- DAVISON PHARMACY LLC
- Practice address
- 1509 S State Rd Ste F
Davison, MI 48423-1966 - Phone
- (810) 210-6095
- NPI assigned
- Sep 20, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin Walsh, PHARMD.
- Title
- Pharmacist in Charge
- Phone
- (810) 412-4666
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2324116 | Davison Pharmacy | Certificate of waiver | May 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221122000166 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4183092299 | Practice locations: Davison, MI |
National Provider Directory
Locations
1509 S State Rd
Ste F
Davison, MI 48423
Phone (810) 210-6095
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1509 S State Rd Ste F
Davison, MI 48423-1966
Mailing address
1509 S State Rd Ste F
Davison, MI 48423-1966
Phone (810) 412-4666
Other names
- Davison Pharmacy
Other providers in Davison, MI
- Davison Drug Store Inc
- Davison Family Dentistry
- Davison Family Dentistry, P.C.
- Davison Medical Practice PLC
- Davison Pediatrics PC
- Davison Physical Therapy Specialists, LLC
- Davison Urgent Care PC
- Davison Vision Center LLC
- Scott Delange
- Julie Derby
All providers in Davison, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.