Healthcare Provider Details

I. General information

NPI: 1164573309
Provider Name (Legal Business Name): JAMES EDWIN STOWE JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E CLAYTON ST
ATHENS GA
30601-2702
US

IV. Provider business mailing address

285 GREAT OAK DR
ATHENS GA
30605-4504
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-3454
  • Fax: 706-543-0244
Mailing address:
  • Phone: 706-543-7978
  • Fax: 706-543-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH010892
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: