Provider Demographics
NPI:1750381919
Name:ALLEN, GEORGIA IRENE (RPH)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:IRENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 JOHN ROLFE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-1428
Mailing Address - Country:US
Mailing Address - Phone:757-565-3293
Mailing Address - Fax:
Practice Address - Street 1:4601 IRONBOUND RD
Practice Address - Street 2:EASTERN STATE HOSPITAL
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2652
Practice Address - Country:US
Practice Address - Phone:757-253-5327
Practice Address - Fax:757-253-4521
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202006340OtherPHARMACIST LICENSE