Provider Demographics
NPI:1386955821
Name:ALLGEN 3 LLC
Entity type:Organization
Organization Name:ALLGEN 3 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIPULKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-409-1075
Mailing Address - Street 1:1240 PROVIDENCE BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7352
Mailing Address - Country:US
Mailing Address - Phone:386-259-5124
Mailing Address - Fax:386-259-5128
Practice Address - Street 1:1240 PROVIDENCE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7352
Practice Address - Country:US
Practice Address - Phone:386-259-5124
Practice Address - Fax:386-259-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH247243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5700895OtherNCPDP PROVIDER IDENTIFICATION NUMBER