MEDICARE: THOMAS P ROWAN DPH

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	4481	TN

General Provider Information

NPI Number	:	1396932729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS P ROWAN DPH

Provider Business Mailing Address
First Line	:	4729 N ROAN ST
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-3959
Country	:	US
Telephone Number	:	423-283-0911
Fax Number	:	423-283-0990

Provider Business Practice Location Address
First Line	:	4729 N ROAN ST
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-3959
Country	:	US
Telephone Number	:	423-283-0911
Fax Number	:	423-283-0990

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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