Provider Demographics
NPI:1144574856
Name:MCGOWAN, MATTHEW JOSEPH (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1914
Mailing Address - Country:US
Mailing Address - Phone:608-437-3001
Mailing Address - Fax:608-437-6480
Practice Address - Street 1:203 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1914
Practice Address - Country:US
Practice Address - Phone:608-437-3001
Practice Address - Fax:608-437-6480
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15931-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist