MEDICARE: DR. NICOLE M MCGOWAN PHARM. D.

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	2012026457	MO

General Provider Information

NPI Number	:	1699021196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE M MCGOWAN PHARM. D.

Provider Business Mailing Address
First Line	:	7955 HIGHWAY N
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7382
Country	:	US
Telephone Number	:	636-625-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	7955 HIGHWAY N
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7382
Country	:	US
Telephone Number	:	636-625-2821
Fax Number	:

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

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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