Healthcare Provider Details

I. General information

NPI: 1487893285
Provider Name (Legal Business Name): ALLSTATE PHARMACEUTICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 PARKER CT SUITE D
STONE MOUNTAIN GA
30087-6400
US

IV. Provider business mailing address

1940 PARKER CT SUITE D
STONE MOUNTAIN GA
30087-6400
US

V. Phone/Fax

Practice location:
  • Phone: 770-978-7400
  • Fax: 770-978-7402
Mailing address:
  • Phone: 770-978-7400
  • Fax: 770-978-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009590
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TED WILLIS
Title or Position: DIRECTOR
Credential:
Phone: 770-978-7400