Provider Demographics
NPI:1306481510
Name:ALLEN, VICTOR (PHARMD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MALL ANX
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4738
Mailing Address - Country:US
Mailing Address - Phone:912-495-8887
Mailing Address - Fax:912-495-8881
Practice Address - Street 1:5 MALL ANX
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4738
Practice Address - Country:US
Practice Address - Phone:912-721-6735
Practice Address - Fax:912-495-8881
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508453994OtherJ.C. LEWIS PRIMARY HEALTH CARE CENTER, INC. PHARMACY NPI
GAPHRE010890OtherJ.C. LEWIS PRIMARY HEALTH CARE CENTER, INC. PHARMACY
GAPHRE010890OtherJ.C. LEWIS PRIMARY HEALTH CARE CENTER, INC. PHARMACY