MEDICARE: DR. ALLEN HA PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0013241	OR
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0013241	OR

General Provider Information

NPI Number	:	1043562440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN HA PHARM D

Provider Business Mailing Address
First Line	:	9211 SE HIGHGATE DR
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-9170
Country	:	US
Telephone Number	:	503-888-6759
Fax Number	:

Provider Business Practice Location Address
First Line	:	9211 SE HIGHGATE DR
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-9170
Country	:	US
Telephone Number	:	503-888-6759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	04/19/2017

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