Provider Demographics
NPI:1548519630
Name:LOWERY, WILLIAM COYET JR
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:COYET
Last Name:LOWERY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:COYET
Other - Last Name:LOWERY
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:1330 DUTCH FORK RD
Mailing Address - City:BALLENTINE
Mailing Address - State:SC
Mailing Address - Zip Code:29002-0000
Mailing Address - Country:US
Mailing Address - Phone:803-749-1666
Mailing Address - Fax:803-749-3591
Practice Address - Street 1:1330 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:BALLENTINE
Practice Address - State:SC
Practice Address - Zip Code:29002-0000
Practice Address - Country:US
Practice Address - Phone:803-749-1666
Practice Address - Fax:803-749-3591
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6780183500000X
GA013842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist