=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710499009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ANDREW ALLEN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2017
-----------------------------------------------------
Last Update Date | 10/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1692 S 4TH ST
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-4747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-353-9000
-----------------------------------------------------
Fax | 760-353-9888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 366 BRYAN POINT DR
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91914-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-952-7373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 54535
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------