Provider Demographics
NPI:1184263261
Name:ALLEN, ERIC WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 OLD HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6098
Mailing Address - Country:US
Mailing Address - Phone:727-421-6432
Mailing Address - Fax:
Practice Address - Street 1:WIN DIXIE PHARMACY #2545
Practice Address - Street 2:2500 BURNSED BLVD
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-753-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist