Provider Demographics
NPI:1518222504
Name:ALLEN, JANE (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:K
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MBA
Mailing Address - Street 1:108 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1760
Mailing Address - Country:US
Mailing Address - Phone:515-505-4836
Mailing Address - Fax:515-967-6539
Practice Address - Street 1:108 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1760
Practice Address - Country:US
Practice Address - Phone:515-505-4836
Practice Address - Fax:515-967-6539
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA21692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist