Provider Demographics
NPI:1750635298
Name:ALLEN, MATTHEW BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRANDON
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 1:515 VAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745
Mailing Address - Country:US
Mailing Address - Phone:423-528-4258
Mailing Address - Fax:
Practice Address - Street 1:515 VAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-528-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22473183500000X
TN38097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist