Provider Demographics
NPI:1174607337
Name:ALLEN PHARMACY SERVICE
Entity type:Organization
Organization Name:ALLEN PHARMACY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-624-3202
Mailing Address - Street 1:23 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-2110
Mailing Address - Country:US
Mailing Address - Phone:208-624-3202
Mailing Address - Fax:208-624-3760
Practice Address - Street 1:23 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-2110
Practice Address - Country:US
Practice Address - Phone:208-624-3202
Practice Address - Fax:208-624-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID322B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4775090001Medicare ID - Type UnspecifiedMEDICARE