MEDICARE: MR. DAVID TRYON GOWER RPH

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	RPH012574	GA

General Provider Information

NPI Number	:	1952682478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID TRYON GOWER RPH

Provider Business Mailing Address
First Line	:	1361 EVERETT MOUNTAIN RD
Second Line	:
City	:	ROCKMART
State	:	GA
Zip	:	30153-4558
Country	:	US
Telephone Number	:	770-546-4206
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 MARTHA BERRY BLVD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1637
Country	:	US
Telephone Number	:	706-295-7787
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	08/30/2011

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