Provider Demographics
NPI:1750390050
Name:ALLEN, DEBRA MAE (RPH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MAE
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 1:5018 E PIERCETON RD
Mailing Address - Street 2:
Mailing Address - City:PIERCETON
Mailing Address - State:IN
Mailing Address - Zip Code:46562-9356
Mailing Address - Country:US
Mailing Address - Phone:574-594-5866
Mailing Address - Fax:
Practice Address - Street 1:5018 E PIERCETON RD
Practice Address - Street 2:
Practice Address - City:PIERCETON
Practice Address - State:IN
Practice Address - Zip Code:46562-9356
Practice Address - Country:US
Practice Address - Phone:574-594-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13744183500000X
ARPD10266183500000X
IN26014520A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26014520AOtherSTATE LICENSE NUMBER
OK13744OtherSTATE LICENSE NUMBER
ARPD10266OtherSTATE LICENSE NUMBER