MEDICARE: DR. MELVIN DOUGLAS OWENS DOCTOR OF PHARMACY

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	020697	GA

General Provider Information

NPI Number	:	1952434425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN DOUGLAS OWENS DOCTOR OF PHARMACY

Provider Business Mailing Address
First Line	:	1824 SMOKERISE SMT
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2324
Country	:	US
Telephone Number	:	678-406-0709
Fax Number	:	678-406-0709

Provider Business Practice Location Address
First Line	:	1824 SMOKERISE SMT
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2324
Country	:	US
Telephone Number	:	678-406-0709
Fax Number	:	678-406-0709

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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