MEDICARE: MRS. ANH MARY ALLEN

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	15538	NV

General Provider Information

NPI Number	:	1861093122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANH MARY ALLEN

Provider Business Mailing Address
First Line	:	9412 WATER FLOW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 W CRAIG RD
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0217
Country	:	US
Telephone Number	:	702-633-6532
Fax Number	:

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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