Healthcare Provider Details

I. General information

NPI: 1780095604
Provider Name (Legal Business Name): ROBERT E STOWELL JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 GRASS VALLEY HWY
AUBURN CA
95603-2536
US

IV. Provider business mailing address

2222 GRASS VALLEY HWY
AUBURN CA
95603-2536
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-8003
  • Fax: 530-889-0739
Mailing address:
  • Phone: 530-889-8003
  • Fax: 530-889-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: