Provider Demographics
NPI:1023841707
Name:DAVIS, COLLIN RYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:RYAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 GRAND AVE # A
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2850
Mailing Address - Country:US
Mailing Address - Phone:402-310-2238
Mailing Address - Fax:
Practice Address - Street 1:1215 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2218
Practice Address - Country:US
Practice Address - Phone:218-724-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist