=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457474512
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD JUDE MCGOWAN R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 COULTER RD
-----------------------------------------------------
City | CLIFTON SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14432-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-462-6181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 JOHNSTON ST
-----------------------------------------------------
City | SENECA FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13148-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-224-0173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 033823
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------