Provider Demographics
NPI:1609362722
Name:ALLEN, ADAM J (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 AL HIGHWAY 14 E
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36703-3201
Mailing Address - Country:US
Mailing Address - Phone:334-874-9359
Mailing Address - Fax:334-874-7383
Practice Address - Street 1:1501 AL HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-3201
Practice Address - Country:US
Practice Address - Phone:334-874-9359
Practice Address - Fax:334-874-7383
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist