Provider Demographics
NPI:1598031684
Name:ALLEN, ELLRIE CRAIG
Entity Type:Individual
Prefix:MR
First Name:ELLRIE
Middle Name:CRAIG
Last Name:ALLEN
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 1:8061 SHENANDOAH RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5434
Mailing Address - Country:US
Mailing Address - Phone:813-907-5438
Mailing Address - Fax:
Practice Address - Street 1:24834 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6252
Practice Address - Country:US
Practice Address - Phone:813-909-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist