Provider Demographics
NPI:1922163146
Name:VOWELL, ALLEN WEST I
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:WEST
Last Name:VOWELL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-0003
Mailing Address - Country:US
Mailing Address - Phone:601-776-2146
Mailing Address - Fax:
Practice Address - Street 1:205 N ARCHUSA AVE
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2416
Practice Address - Country:US
Practice Address - Phone:601-776-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030254Medicaid
MS2506840OtherNABP