MEDICARE: DR. AMY FOWLER PAINVIN

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	1835P2201X	Ambulatory Care Pharmacist	1356454	OH

General Provider Information

NPI Number	:	1710583745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY FOWLER PAINVIN

Provider Business Mailing Address
First Line	:	9608 RIVERWAY RUN
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-8374
Country	:	US
Telephone Number	:	415-577-0149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6320
Country	:	US
Telephone Number	:	614-268-8090
Fax Number	:

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

Provider Enumeration Date	:	12/06/2020
Last Update Date	:	12/06/2020

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