Healthcare Provider Details

I. General information

NPI: 1336319193
Provider Name (Legal Business Name): MAX W ALLEN B.S.,DPH, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2008
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19823 N 95TH AVE
PEORIA AZ
85382-4157
US

IV. Provider business mailing address

19823 N 95TH AVE
PEORIA AZ
85382-4157
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-3997
  • Fax:
Mailing address:
  • Phone: 623-523-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberS014485
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: