MEDICARE: DR. BENJAMIN REID 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	03132508	OH
2	183500000X	Pharmacist	26024904A	IN

General Provider Information

NPI Number	:	1245572098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN REID ALLEN PHARMD

Provider Business Mailing Address
First Line	:	13028 TONKEL RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9226
Country	:	US
Telephone Number	:	260-403-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1708
Country	:	US
Telephone Number	:	937-254-2156
Fax Number	:

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/20/2013

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