MEDICARE: MELISSA FOWLER 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	5042929-1701	UT

General Provider Information

NPI Number	:	1841510096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA FOWLER PHARM.D.

Provider Business Mailing Address
First Line	:	828 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1455
Country	:	US
Telephone Number	:	801-364-2564
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 S 900 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1455
Country	:	US
Telephone Number	:	801-364-2564
Fax Number	:

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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