Provider Demographics
NPI:1942645908
Name:PRIMROSE, L ALLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:L
Middle Name:ALLEN
Last Name:PRIMROSE
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 1:7826 E US HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-9048
Mailing Address - Country:US
Mailing Address - Phone:731-585-0500
Mailing Address - Fax:731-585-0506
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-2147
Practice Address - Country:US
Practice Address - Phone:731-585-0500
Practice Address - Fax:731-585-0506
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist