Provider Demographics
NPI:1912280249
Name:WORTHINGTON, ALAN CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:CRAIG
Last Name:WORTHINGTON
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 1:2307 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4819
Mailing Address - Country:US
Mailing Address - Phone:515-232-6527
Mailing Address - Fax:
Practice Address - Street 1:2719 GRAND AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4659
Practice Address - Country:US
Practice Address - Phone:515-232-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist