Healthcare Provider Details

I. General information

NPI: 1174607337
Provider Name (Legal Business Name): ALLEN PHARMACY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N BRIDGE ST
SAINT ANTHONY ID
83445-2110
US

IV. Provider business mailing address

23 N BRIDGE ST
SAINT ANTHONY ID
83445-2110
US

V. Phone/Fax

Practice location:
  • Phone: 208-624-3202
  • Fax: 208-624-3760
Mailing address:
  • Phone: 208-624-3202
  • Fax: 208-624-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number322B00000X
License Number StateID

VIII. Authorized Official

Name: PAUL A ALLEN
Title or Position: PRESIDENT
Credential:
Phone: 208-624-3202