Provider Demographics
NPI:1366529034
Name:ALLEN NEIGHBORHOOD PHARMACY INC
Entity type:Organization
Organization Name:ALLEN NEIGHBORHOOD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-857-2492
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-0311
Mailing Address - Country:US
Mailing Address - Phone:580-857-2492
Mailing Address - Fax:580-857-2495
Practice Address - Street 1:200 E LEXINGTON
Practice Address - Street 2:200 EAST LEXINGTON
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825-9224
Practice Address - Country:US
Practice Address - Phone:580-857-2492
Practice Address - Fax:580-272-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2352853336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072617OtherPK
OK100244820AMedicaid