Healthcare Provider Details

I. General information

NPI: 1104110154
Provider Name (Legal Business Name): AMY MARIE LOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 RESEARCH BLVD T-2409
AUSTIN TX
78759-5803
US

IV. Provider business mailing address

10107 RESEARCH BLVD T-2409
AUSTIN TX
78759-5803
US

V. Phone/Fax

Practice location:
  • Phone: 512-687-1316
  • Fax: 512-687-1326
Mailing address:
  • Phone: 512-687-1316
  • Fax: 512-687-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45753
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10911
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: