MEDICARE: MS. CAITLIN MARY MOWERS PHARMD

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	I057620-1	NY
2	183500000X	Pharmacist	0011985	CT

General Provider Information

NPI Number	:	1619380474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLIN MARY MOWERS PHARMD

Provider Business Mailing Address
First Line	:	4 ELLIOTT PL
Second Line	:	PO BOX 352
City	:	CLINTON
State	:	NY
Zip	:	13323-1408
Country	:	US
Telephone Number	:	315-697-7595
Fax Number	:	315-697-9618

Provider Business Practice Location Address
First Line	:	423 S PETERBORO ST
Second Line	:
City	:	CANASTOTA
State	:	NY
Zip	:	13032-1431
Country	:	US
Telephone Number	:	315-697-7595
Fax Number	:	315-697-9618

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/09/2014

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