Provider Demographics
NPI:1174856371
Name:ANDERSON, ALLEN D (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:D
Last Name:ANDERSON
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 1:1251 NW THORN DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9207
Mailing Address - Country:US
Mailing Address - Phone:541-926-7334
Mailing Address - Fax:
Practice Address - Street 1:1700 PACIFIC BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-4833
Practice Address - Country:US
Practice Address - Phone:541-926-5214
Practice Address - Fax:541-926-8601
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist