MEDICARE: MARK ROBERT OWENS 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	1835P2201X	Ambulatory Care Pharmacist	13795-040	WI

General Provider Information

NPI Number	:	1811851413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROBERT OWENS PHARMD

Provider Business Mailing Address
First Line	:	15225 W SMALL RD
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-7936
Country	:	US
Telephone Number	:	262-599-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	15225 W SMALL RD
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-7936
Country	:	US
Telephone Number	:	262-599-7040
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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