Provider Demographics
NPI:1184998080
Name:ALLERMED PHARMACY
Entity type:Organization
Organization Name:ALLERMED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-292-1060
Mailing Address - Street 1:7203 CONVOY CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1020
Mailing Address - Country:US
Mailing Address - Phone:858-292-1060
Mailing Address - Fax:858-292-5934
Practice Address - Street 1:7203 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1020
Practice Address - Country:US
Practice Address - Phone:858-292-1060
Practice Address - Fax:858-292-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY505923336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy