Healthcare Provider Details

I. General information

NPI: 1982985669
Provider Name (Legal Business Name): ALLEN WILLIAM HAUSER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOPE DR
MOUNTAIN HOME AFB ID
83648-1057
US

IV. Provider business mailing address

1051 SOUTHERN DR APARTMENT 3701
COLUMBIA SC
29201-5189
US

V. Phone/Fax

Practice location:
  • Phone: 208-828-7693
  • Fax:
Mailing address:
  • Phone: 704-942-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: