Provider Demographics
NPI:1740698380
Name:ALLEN, DEANNA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6013
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-6013
Mailing Address - Country:US
Mailing Address - Phone:949-291-3120
Mailing Address - Fax:
Practice Address - Street 1:4561 S CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6248
Practice Address - Country:US
Practice Address - Phone:310-822-6354
Practice Address - Fax:310-822-6540
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 28533183500000X
HIPH 2844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist