Provider Demographics
NPI:1316210453
Name:ALLEN, SANDRA PAULINE (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:PAULINE
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 1:53 N. SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-482-3366
Mailing Address - Fax:541-482-2736
Practice Address - Street 1:53 N. SECOND ST.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-482-3366
Practice Address - Fax:541-482-2736
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist