MEDICARE: ROWAN ENTERPRISES INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	2064	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4425004	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1568599306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROWAN ENTERPRISES INC

Provider Business Mailing Address
First Line	:	4729 N ROAN ST
Second Line	:	STE 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	:	STE 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	:	PRESIDENT AND OWNER
Name	:	THOMAS ROWAN
Credential	:	DPH
Telephone Number	:	423-283-0911

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/19/2009

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Directions to “ROWAN ENTERPRISES INC ” Practice Location

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