Provider Demographics
NPI:1669650115
Name:SUE JOHNSON ALLEN
Entity Type:Organization
Organization Name:SUE JOHNSON ALLEN
Other - Org Name:SUE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-322-4326
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0188
Mailing Address - Country:US
Mailing Address - Phone:903-322-4326
Mailing Address - Fax:903-322-5152
Practice Address - Street 1:303 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-4326
Practice Address - Fax:903-322-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0080876332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4151510001Medicare NSC