Provider Demographics
NPI:1194040832
Name:ALLEN, DENISE DAVIS (RPH)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:DAVIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 ALABAMA HWY 168
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957
Mailing Address - Country:US
Mailing Address - Phone:256-593-6546
Mailing Address - Fax:256-593-3137
Practice Address - Street 1:196 UNION GROVE RD S
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3001
Practice Address - Country:US
Practice Address - Phone:256-528-7506
Practice Address - Fax:256-593-3137
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist