MEDICARE: MR. MICHAEL WAISTELL COWAN

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	RP438948	PA

General Provider Information

NPI Number	:	1457650400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WAISTELL COWAN

Provider Business Mailing Address
First Line	:	1814 SPRING RD
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-1150
Country	:	US
Telephone Number	:	717-249-7697
Fax Number	:	717-960-4523

Provider Business Practice Location Address
First Line	:	1814 SPRING RD
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-1150
Country	:	US
Telephone Number	:	717-249-7697
Fax Number	:	717-960-4523

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

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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Directions to “ MR. MICHAEL WAISTELL COWAN ” Practice Location

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