Healthcare Provider Details

I. General information

NPI: 1669791851
Provider Name (Legal Business Name): WILLIAM BRENT COWLEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 E BIDWELL ST
FOLSOM CA
95630-3119
US

IV. Provider business mailing address

526 E BIDWELL ST
FOLSOM CA
95630-3119
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-7749
  • Fax: 916-984-7762
Mailing address:
  • Phone: 916-984-7749
  • Fax: 916-984-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41504
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number150187-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: