Healthcare Provider Details

I. General information

NPI: 1629145131
Provider Name (Legal Business Name): KIMBERLY ANN COWHY R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 10TH ST
PORT HURON MI
48060-5815
US

IV. Provider business mailing address

10185 FOLEY RD
KENOCKEE MI
48006-3105
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-3100
  • Fax: 810-982-3106
Mailing address:
  • Phone: 810-650-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027633
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302027633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: