Provider Demographics
NPI:1285943167
Name:ALLEN, NATHAN BRYAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BRYAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3322
Mailing Address - Country:US
Mailing Address - Phone:928-757-0049
Mailing Address - Fax:928-763-1869
Practice Address - Street 1:1775 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5732
Practice Address - Country:US
Practice Address - Phone:928-763-8777
Practice Address - Fax:928-763-1869
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014877183500000X
NV17111183500000X
UT4730956-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist