Healthcare Provider Details

I. General information

NPI: 1700102373
Provider Name (Legal Business Name): CAROL M KOWACH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

IV. Provider business mailing address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax: 330-740-9249
Mailing address:
  • Phone: 330-740-9200
  • Fax: 330-740-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03316119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: