Basic Information
| Provider Information | |||||||||
| NPI: | 1306481510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 MALL ANX | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
| FaxNumber: | 9124958881 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MALL ANX | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127216735 | ||||||||
| FaxNumber: | 9124958881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2019 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH031795 | GA | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | PHRE010890 | 01 | GA | J.C. LEWIS PRIMARY HEALTH CARE CENTER, INC. PHARMACY | OTHER | 1508453994 | 01 | GA | J.C. LEWIS PRIMARY HEALTH CARE CENTER, INC. PHARMACY NPI | OTHER |