MEDICARE: DR. DUSTY JAMES ALLEN PHARMD

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	13783	OK
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	13783	OK

General Provider Information

NPI Number	:	1144427030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTY JAMES ALLEN PHARMD

Provider Business Mailing Address
First Line	:	1201 S BELMONT AVE STE 106
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6351
Country	:	US
Telephone Number	:	918-756-9906
Fax Number	:	918-756-2464

Provider Business Practice Location Address
First Line	:	1201 S BELMONT AVE
Second Line	:	BAKER BUILDING SUITE 106
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6351
Country	:	US
Telephone Number	:	918-758-9498
Fax Number	:	918-756-2464

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/13/2021

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