Healthcare Provider Details

I. General information

NPI: 1427333020
Provider Name (Legal Business Name): JUDITH ALLEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 JONESBORO RD
UNION CITY GA
30291-2048
US

IV. Provider business mailing address

9105 VALLEYVIEW CT
UNION CITY GA
30291-6077
US

V. Phone/Fax

Practice location:
  • Phone: 770-969-7458
  • Fax: 770-969-9586
Mailing address:
  • Phone: 678-523-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH023390
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: