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General NPI Number Information
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NPI Number | 1144824202
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Entity Type | Individual
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Provider Name | TRIEJAYE MCDOWELL PHARM D
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Gender | Female
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 4843 BLUESTEM RD
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City | ROSCOE
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State | IL
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Zip | 61073-7794
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Country | US
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Telephone | 815-623-1696
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Fax |
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Provider Business Mailing Address
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Address Line | 419 JOHN ST APT 109
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City | ROCKFORD
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State | IL
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Zip | 61103-7052
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Country | US
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Telephone | 773-946-0560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051300412
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License Number State | IL
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