Healthcare Provider Details

I. General information

NPI: 1205847159
Provider Name (Legal Business Name): MICHAEL D STOWERS DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N GLENN L ENGLISH ST
CORDELL OK
73632-2009
US

IV. Provider business mailing address

121 W TAHOE DR
CORDELL OK
73632-4844
US

V. Phone/Fax

Practice location:
  • Phone: 580-832-3714
  • Fax: 580-832-3331
Mailing address:
  • Phone: 580-832-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9069
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: