Provider Demographics
NPI:1639945439
Name:ALLEN, DANNY RAY (BCNP)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:RAY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2120
Mailing Address - Country:US
Mailing Address - Phone:903-574-0488
Mailing Address - Fax:903-595-3788
Practice Address - Street 1:1301 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2120
Practice Address - Country:US
Practice Address - Phone:903-574-0488
Practice Address - Fax:903-595-3788
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250171835N0905X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear