Provider Demographics
NPI:1740300771
Name:KART, ALLAN I (RPH)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:I
Last Name:KART
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 1:96190 LONG BEACH DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8719
Mailing Address - Country:US
Mailing Address - Phone:904-548-1142
Mailing Address - Fax:
Practice Address - Street 1:1351 BOONE AVENUE EXT E
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6515
Practice Address - Country:US
Practice Address - Phone:912-729-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00641539HMedicaid