NPI 1013431162

Broxton Thayne Davis, PHARMD

Practitioner Pharmacist Mishawaka, IN

Practice location

Address: 420 W 4th St, Mishawaka, IN 46544-1948
Phone: (574) 307-7673
Mailing address: 2401 Valley Dr, Valparaiso, IN 46383-2520

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 26027265A (IN)

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Registry record

NPI: 1013431162
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Jul 2017
Record last updated: 20 Feb 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.