1639234057 NPI number — ALLEN PHARMACY INC

Table of content: (NPI 1639234057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639234057 NPI number — ALLEN PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639234057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERFORD
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73096-0389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 E FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73096-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-772-3347
Provider Business Practice Location Address Fax Number:
580-772-3350
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAUGHMAN
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST MANAGER
Authorized Official Telephone Number:
580-772-3347

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  281567 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100232030A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2073336 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com