Provider Demographics
NPI:1922666213
Name:ALLEN, LORI LYNN NELSON
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN NELSON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 S 40TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0559
Mailing Address - Country:US
Mailing Address - Phone:480-706-0620
Mailing Address - Fax:480-706-0489
Practice Address - Street 1:16515 S 40TH ST STE 123
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0559
Practice Address - Country:US
Practice Address - Phone:480-706-0620
Practice Address - Fax:480-706-0489
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS9955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS009955OtherARIZONA BOARD OF PHARMACY LICENSE