Healthcare Provider Details

I. General information

NPI: 1801300173
Provider Name (Legal Business Name): MATTHEW G ALLEN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 11/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 COURT ST
CATLETTSBURG KY
41129-1011
US

IV. Provider business mailing address

3501 COURT ST
CATLETTSBURG KY
41129-1011
US

V. Phone/Fax

Practice location:
  • Phone: 606-739-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014497
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: