Healthcare Provider Details

I. General information

NPI: 1649385949
Provider Name (Legal Business Name): JOHN A. MCGOWAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON DRIVE
JACKSON MS
39216-5199
US

IV. Provider business mailing address

328 DOVER LN
MADISON MS
39110-9418
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1555
  • Fax:
Mailing address:
  • Phone: 601-856-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-5901
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: