Healthcare Provider Details

I. General information

NPI: 1962979500
Provider Name (Legal Business Name): JIA K ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509-2523 PENNSYLVANIA AVE
BALTIMORE MD
21217
US

IV. Provider business mailing address

1 CVS DR
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-2091
  • Fax:
Mailing address:
  • Phone: 800-746-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25996
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: