MEDICARE: ALLEN PHARMACY SERVICES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	1740CP	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020328	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194736694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	23 N BRIDGE ST
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-2110
Country	:	US
Telephone Number	:	208-624-3202
Fax Number	:	208-624-3760

Provider Business Practice Location Address
First Line	:	23 N BRIDGE ST
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-2110
Country	:	US
Telephone Number	:	208-624-3202
Fax Number	:	208-624-3760

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL ALLEN
Credential	:
Telephone Number	:	208-624-3202

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/20/2016

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