Provider Demographics
NPI:1811264922
Name:ALLISON, BRIAN DAVID (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:ALLISON
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 1:16059 GARNET LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-6454
Mailing Address - Country:US
Mailing Address - Phone:309-264-3462
Mailing Address - Fax:
Practice Address - Street 1:221 N BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2748
Practice Address - Country:US
Practice Address - Phone:309-383-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist