Provider Demographics
NPI:1306669668
Name:ALLEN, ALEXANDER (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7822 OBERON RD APT C
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5650
Mailing Address - Country:US
Mailing Address - Phone:307-871-7021
Mailing Address - Fax:
Practice Address - Street 1:12700 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5251
Practice Address - Country:US
Practice Address - Phone:303-237-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0025017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000238291Medicaid