Healthcare Provider Details

I. General information

NPI: 1912004326
Provider Name (Legal Business Name): JACQUELINE ANN LOWE RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S BUFFALO ST
WARSAW IN
46580-4307
US

IV. Provider business mailing address

1583 S MEADOW DR
WARSAW IN
46580-7014
US

V. Phone/Fax

Practice location:
  • Phone: 574-268-2010
  • Fax: 574-268-1045
Mailing address:
  • Phone: 574-267-1862
  • Fax: 574-268-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26014250A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: