Healthcare Provider Details

I. General information

NPI: 1942532247
Provider Name (Legal Business Name): ANDREW HENRY KOWAL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 POMEROY MEADOW RD R
SOUTHAMPTON MA
01073-9331
US

IV. Provider business mailing address

153 POMEROY MEADOW RD R
SOUTHAMPTON MA
01073-9331
US

V. Phone/Fax

Practice location:
  • Phone: 413-527-3699
  • Fax: 800-565-8182
Mailing address:
  • Phone: 413-527-3699
  • Fax: 800-565-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21250
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: