Provider Demographics
NPI:1265568455
Name:ALLEN, ROSE M (R PH)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:R. M.
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:R PH
Mailing Address - Street 1:PO BOX 32126
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-0126
Mailing Address - Country:US
Mailing Address - Phone:216-289-2266
Mailing Address - Fax:
Practice Address - Street 1:26241 LAKE SHORE BLVD
Practice Address - Street 2:SUITE 1053
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1177
Practice Address - Country:US
Practice Address - Phone:216-289-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03212868183500000X
CO14509183500000X
TX19471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist