Provider Demographics
NPI:1417000258
Name:ALLEN, ANNIE HOGAN (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:HOGAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26377 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:AL
Mailing Address - Zip Code:35739-8029
Mailing Address - Country:US
Mailing Address - Phone:256-423-4756
Mailing Address - Fax:
Practice Address - Street 1:30508 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:AL
Practice Address - Zip Code:35739-7443
Practice Address - Country:US
Practice Address - Phone:256-423-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist