Provider Demographics
NPI:1467057695
Name:ALLEN, TAYLOR DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DEAN
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 1:1130 NATIONAL RD APT 9
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5711
Mailing Address - Country:US
Mailing Address - Phone:740-630-7200
Mailing Address - Fax:
Practice Address - Street 1:1114 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2313
Practice Address - Country:US
Practice Address - Phone:304-845-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440358183500000X
WVRP0012286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist