Provider Demographics
NPI:1801919774
Name:PLYMALE, ALLEN EDWARD (PHC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:EDWARD
Last Name:PLYMALE
Suffix:
Gender:M
Credentials:PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S COPPER
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5010
Mailing Address - Country:US
Mailing Address - Phone:575-544-7507
Mailing Address - Fax:
Practice Address - Street 1:122 S GOLD AVE STE 3
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3755
Practice Address - Country:US
Practice Address - Phone:575-544-7280
Practice Address - Fax:575-544-7281
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC 48183500000X
NMPC000000481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist