Healthcare Provider Details

I. General information

NPI: 1811846777
Provider Name (Legal Business Name): JUSTIN ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BUTLER ST STE A
MIDWAY GA
31320-4294
US

IV. Provider business mailing address

90 BUTLER ST STE A
MIDWAY GA
31320-4294
US

V. Phone/Fax

Practice location:
  • Phone: 912-884-9255
  • Fax: 912-884-9257
Mailing address:
  • Phone: 912-884-9255
  • Fax: 912-884-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035780
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: