Provider Demographics
NPI:1922574656
Name:ALLIS, LONNY
Entity Type:Individual
Prefix:
First Name:LONNY
Middle Name:
Last Name:ALLIS
Suffix:
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 1:2320 W PEORIA AVE STE D132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4768
Mailing Address - Country:US
Mailing Address - Phone:877-678-5400
Mailing Address - Fax:877-678-5401
Practice Address - Street 1:2320 W PEORIA AVE STE D132
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4768
Practice Address - Country:US
Practice Address - Phone:877-678-5400
Practice Address - Fax:877-678-5401
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist