Provider Demographics
NPI:1619481959
Name:ALLEN, DOUGLAS MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 RIVER LANDINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7853
Mailing Address - Country:US
Mailing Address - Phone:419-340-9667
Mailing Address - Fax:
Practice Address - Street 1:2525 HILLIARD ROME RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9471
Practice Address - Country:US
Practice Address - Phone:614-771-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist