=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811851413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ROBERT OWENS PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15225 W SMALL RD
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-7936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-599-7040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15225 W SMALL RD
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-7936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-599-7040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 13795-040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------