Provider Demographics
NPI:1215216411
Name:ALLEN, DUSTIN MATHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:MATHEW
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 1:1039 LOWES LN
Mailing Address - Street 2:
Mailing Address - City:IRON STATION
Mailing Address - State:NC
Mailing Address - Zip Code:28080-9647
Mailing Address - Country:US
Mailing Address - Phone:704-310-8059
Mailing Address - Fax:
Practice Address - Street 1:4428 TAGGART CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5400
Practice Address - Country:US
Practice Address - Phone:704-943-9639
Practice Address - Fax:704-536-9812
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist