Provider Demographics
NPI:1720099302
Name:DR ALLENS DRUGSTORE
Entity Type:Organization
Organization Name:DR ALLENS DRUGSTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-251-6363
Mailing Address - Street 1:PO BOX 31084
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-1084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 N GILBERT RD
Practice Address - Street 2:STE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5136
Practice Address - Country:US
Practice Address - Phone:480-844-1600
Practice Address - Fax:480-844-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0354338OtherOTHER ID NUMBER-COMMERCIAL NUMBER