MEDICARE: ALLENS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	RP024515L	PA
2	333600000X	Pharmacy	PP410051L	PA

General Provider Information

NPI Number	:	1376547398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLENS PHARMACY INC

Provider Business Mailing Address
First Line	:	402 PRESCOTT AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18510-2399
Country	:	US
Telephone Number	:	570-342-8219
Fax Number	:	570-342-8219

Provider Business Practice Location Address
First Line	:	402 PRESCOTT AVE
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18510-2399
Country	:	US
Telephone Number	:	570-342-8219
Fax Number	:	570-342-8219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS G ALLEN
Credential	:	RPH
Telephone Number	:	570-342-8219

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/15/2008

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