Provider Demographics
NPI:1497063788
Name:ALLEN, CAREY MICHAEL (DPH)
Entity Type:Individual
Prefix:MR
First Name:CAREY
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1217
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-1217
Mailing Address - Country:US
Mailing Address - Phone:615-672-9034
Mailing Address - Fax:615-672-9505
Practice Address - Street 1:3012 HIGHWAY 31 W
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8970
Practice Address - Country:US
Practice Address - Phone:615-672-9034
Practice Address - Fax:615-672-9505
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist