Provider Demographics
NPI:1144427030
Name:ALLEN, DUSTY JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTY
Middle Name:JAMES
Last Name:ALLEN
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 1:1201 S BELMONT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6351
Mailing Address - Country:US
Mailing Address - Phone:918-756-9906
Mailing Address - Fax:918-756-2464
Practice Address - Street 1:1201 S BELMONT AVE
Practice Address - Street 2:BAKER BUILDING SUITE 106
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6351
Practice Address - Country:US
Practice Address - Phone:918-758-9498
Practice Address - Fax:918-756-2464
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13783183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty