Provider Demographics
NPI:1407088032
Name:ALLEN, BRANDY GRACE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:GRACE
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 1:1308 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2401
Mailing Address - Country:US
Mailing Address - Phone:681-529-1313
Mailing Address - Fax:
Practice Address - Street 1:1308 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2401
Practice Address - Country:US
Practice Address - Phone:681-529-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012589183500000X
OR9910183500000X
VI244183500000X
HI3072183500000X
FLPS47514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist