Healthcare Provider Details

I. General information

NPI: 1265818272
Provider Name (Legal Business Name): COREY FOWLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

312 18TH ST NE # A
WASHINGTON DC
20002-6608
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-5000
  • Fax:
Mailing address:
  • Phone: 803-528-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH200005273
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55438
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35589
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: