Healthcare Provider Details

I. General information

NPI: 1194040832
Provider Name (Legal Business Name): DENISE DAVIS ALLEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 UNION GROVE RD S
CROSSVILLE AL
35962-3001
US

IV. Provider business mailing address

10402 ALABAMA HWY 168
BOAZ AL
35957
US

V. Phone/Fax

Practice location:
  • Phone: 256-528-7506
  • Fax: 256-593-3137
Mailing address:
  • Phone: 256-593-6546
  • Fax: 256-593-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11996
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: