Provider Demographics
NPI:1073812855
Name:ALLRED, MICHAEL LINDSAY (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LINDSAY
Last Name:ALLRED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0864
Mailing Address - Country:US
Mailing Address - Phone:910-763-3367
Mailing Address - Fax:910-762-1535
Practice Address - Street 1:3501 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0864
Practice Address - Country:US
Practice Address - Phone:910-763-3367
Practice Address - Fax:910-762-1535
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist