Provider Demographics
NPI:1164625844
Name:ALLEN, NICHOLAS MARK
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MARK
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 GILES RD APT 112
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3382
Mailing Address - Country:US
Mailing Address - Phone:402-670-8005
Mailing Address - Fax:402-592-2501
Practice Address - Street 1:11134 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3609
Practice Address - Country:US
Practice Address - Phone:402-592-5244
Practice Address - Fax:402-592-2501
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician