Provider Demographics
NPI:1922344498
Name:ALLEN PHARMACY GROUP, LLC
Entity Type:Organization
Organization Name:ALLEN PHARMACY GROUP, LLC
Other - Org Name:TIFTON DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-563-1143
Mailing Address - Street 1:602 LOVE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4406
Mailing Address - Country:US
Mailing Address - Phone:229-396-5552
Mailing Address - Fax:229-396-5558
Practice Address - Street 1:602 LOVE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4406
Practice Address - Country:US
Practice Address - Phone:229-396-5552
Practice Address - Fax:229-396-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0098903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130185AMedicaid