MEDICARE: DR. ALLYSON LYNNAE ANGLIN PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH029344	GA

General Provider Information

NPI Number	:	1487287025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLYSON LYNNAE ANGLIN PHARMD

Provider Business Mailing Address
First Line	:	3479 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2735
Country	:	US
Telephone Number	:	404-286-5788
Fax Number	:	404-286-6749

Provider Business Practice Location Address
First Line	:	3479 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2735
Country	:	US
Telephone Number	:	404-286-5788
Fax Number	:	404-286-6749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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