Healthcare Provider Details

I. General information

NPI: 1861924342
Provider Name (Legal Business Name): MARY FOWLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 N 2ND ST # 604
HARRISON MI
48625-2545
US

IV. Provider business mailing address

182 N 2ND ST PO BOX 604
HARRISON MI
48625-2545
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2900
  • Fax: 989-368-1304
Mailing address:
  • Phone: 989-539-2900
  • Fax: 989-368-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: