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General NPI Number Information
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NPI Number | 1295011054
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Entity Type | Individual
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Provider Name | MR. JEFFREY LEE ALLEN
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Gender | Male
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 2920 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-240-5077
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Fax | 636-978-2162
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Provider Business Mailing Address
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Address Line | 4 TINDERBOX CT
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City | O FALLON
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State | MO
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Zip | 63368-8266
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Country | US
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Telephone | 636-240-2601
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Fax | 636-978-2162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 043104
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License Number State | MO
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