Healthcare Provider Details

I. General information

NPI: 1609322213
Provider Name (Legal Business Name): DR. TOM COWDEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N. GRAND BLVD
ST. LOUIS MO
63123
US

IV. Provider business mailing address

7545 HARLAN WALK
SAINT LOUIS MO
63123-2840
US

V. Phone/Fax

Practice location:
  • Phone: 813-777-0074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: