Provider Demographics
NPI:1497046866
Name:ALLRED, BRENT D
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:D
Last Name:ALLRED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1415
Mailing Address - Country:US
Mailing Address - Phone:814-864-1282
Mailing Address - Fax:
Practice Address - Street 1:1338 E GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2736
Practice Address - Country:US
Practice Address - Phone:814-825-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032200L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist