Healthcare Provider Details

I. General information

NPI: 1871047860
Provider Name (Legal Business Name): ALLERGY ALL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 MAIN ST
KEOKUK IA
52632-5450
US

IV. Provider business mailing address

5055 CARRIAGE BRIDGE LN
CUMMING GA
30040-6164
US

V. Phone/Fax

Practice location:
  • Phone: 972-922-8242
  • Fax:
Mailing address:
  • Phone: 972-922-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberN0282
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberN0282
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberN0282
License Number StateTX

VIII. Authorized Official

Name: MRS. ABBY WRIGHT
Title or Position: OWNER/CEO
Credential:
Phone: 972-922-8242