MEDICARE: MRS. BRENDA JEAN FOWLER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17633	IA

General Provider Information

NPI Number	:	1437195294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA JEAN FOWLER RPH

Provider Business Mailing Address
First Line	:	356 AUSTIN ST
Second Line	:
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579-1027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 W MAIN ST
Second Line	:
City	:	SAC CITY
State	:	IA
Zip	:	50583-1727
Country	:	US
Telephone Number	:	712-662-7146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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