Provider Demographics
NPI:1578622528
Name:ALLEN, REBECCA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:FORT SHAW
Mailing Address - State:MT
Mailing Address - Zip Code:59443-9724
Mailing Address - Country:US
Mailing Address - Phone:406-264-5168
Mailing Address - Fax:
Practice Address - Street 1:2509 7TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3030
Practice Address - Country:US
Practice Address - Phone:406-761-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist