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General NPI Number Information
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NPI Number | 1336812700
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Entity Type | Individual
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Provider Name | NATHAN ROBERT ALEXANDER ALLEN RPH
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Gender | Male
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 2996 CHURCH RD E
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9825
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Country | US
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Telephone | 662-349-4418
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Fax |
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Provider Business Mailing Address
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Address Line | 9129 LAKESHORE DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1532
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Country | US
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Telephone | 662-671-9551
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Fax |
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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 | E-100286
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License Number State | MS
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