Healthcare Provider Details

I. General information

NPI: 1699021196
Provider Name (Legal Business Name): NICOLE M MCGOWAN PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7955 HIGHWAY N
DARDENNE PRAIRIE MO
63368-7382
US

IV. Provider business mailing address

7955 HIGHWAY N
DARDENNE PRAIRIE MO
63368-7382
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-2821
  • Fax:
Mailing address:
  • Phone: 636-625-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2012026457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: