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General NPI Number Information
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NPI Number | 1265818272
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Entity Type | Individual
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Provider Name | COREY FOWLER PHAMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 800 ROSE STREET
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City | LEXINGTON
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State | KY
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Zip | 40536
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Country | US
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Telephone | 859-330-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 RAPID RUN DRIVE APT. 816
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City | LEXINGTON
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State | KY
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Zip | 40515
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Country | US
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Telephone | 803-528-8818
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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 | 35589
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License Number State | SC
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