MEDICARE: MS. DENISE DAVIS ALLEN RPH

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	11996	AL

General Provider Information

NPI Number	:	1194040832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE DAVIS ALLEN RPH

Provider Business Mailing Address
First Line	:	10402 ALABAMA HWY 168
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35957
Country	:	US
Telephone Number	:	256-593-6546
Fax Number	:	256-593-3137

Provider Business Practice Location Address
First Line	:	196 UNION GROVE RD S
Second Line	:
City	:	CROSSVILLE
State	:	AL
Zip	:	35962-3001
Country	:	US
Telephone Number	:	256-528-7506
Fax Number	:	256-593-3137

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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