Healthcare Provider Details

I. General information

NPI: 1689997579
Provider Name (Legal Business Name): DAWN MARIE KOWALSKI RPH, PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 7TH AVE
MENOMINEE MI
49858-3130
US

IV. Provider business mailing address

1101 7TH AVE
MENOMINEE MI
49858-3130
US

V. Phone/Fax

Practice location:
  • Phone: 906-863-4471
  • Fax: 906-863-2108
Mailing address:
  • Phone: 906-863-4471
  • Fax: 906-863-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031915
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: