Provider Demographics
NPI:1689685398
Name:ALLEN, WILLIAM CLYDE (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLYDE
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 1:5052 BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3130
Mailing Address - Country:US
Mailing Address - Phone:229-794-2774
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1123
Practice Address - Country:US
Practice Address - Phone:229-794-2776
Practice Address - Fax:229-794-3248
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist