MEDICARE: KELLY COWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119254	MN

General Provider Information

NPI Number	:	1184900482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY COWELL

Provider Business Mailing Address
First Line	:	1431 W LAIR RD
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-6005
Country	:	US
Telephone Number	:	612-655-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 S STATE ST
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4441
Country	:	US
Telephone Number	:	507-238-2880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	03/24/2023

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Directions to “ KELLY COWELL ” Practice Location

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