Provider Demographics
NPI:1295479491
Name:EGGERS, ALLISON RENEE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:EGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RENEE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22600 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2313
Mailing Address - Country:US
Mailing Address - Phone:586-772-6699
Mailing Address - Fax:586-772-1339
Practice Address - Street 1:22600 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2313
Practice Address - Country:US
Practice Address - Phone:586-772-6699
Practice Address - Fax:586-772-1339
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303041462183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician