Provider Demographics
NPI:1235287111
Name:ALLEN, NICK A (RPH)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:A
Last Name:ALLEN
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 1:436 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1383
Mailing Address - Country:US
Mailing Address - Phone:620-473-2734
Mailing Address - Fax:620-431-7741
Practice Address - Street 1:436 CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-1383
Practice Address - Country:US
Practice Address - Phone:620-473-2734
Practice Address - Fax:620-431-7741
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist