Healthcare Provider Details

I. General information

NPI: 1922700293
Provider Name (Legal Business Name): AMY RANAE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MANZANITA AVE
CARMICHAEL CA
95608-1724
US

IV. Provider business mailing address

4010 MANZANITA AVE
CARMICHAEL CA
95608-1724
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-4930
  • Fax: 916-482-1840
Mailing address:
  • Phone: 916-482-4930
  • Fax: 916-482-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: