Provider Demographics
NPI:1417181892
Name:ALLEN, ANN A (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:A
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 1:1315 JAMBALANA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8807
Mailing Address - Country:US
Mailing Address - Phone:239-362-0791
Mailing Address - Fax:
Practice Address - Street 1:1315 JAMBALANA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8807
Practice Address - Country:US
Practice Address - Phone:239-362-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0030720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0030720OtherPHARMACIST LICENSE