Provider Demographics
NPI:1477145787
Name:ALLEN, EDWIN JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-4002
Mailing Address - Country:US
Mailing Address - Phone:443-278-6193
Mailing Address - Fax:
Practice Address - Street 1:820 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4324
Practice Address - Country:US
Practice Address - Phone:717-757-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453397183500000X
MD25395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist