Provider Demographics
NPI:1861924342
Name:FOWLER, MARY (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 N 2ND ST
Mailing Address - Street 2:PO BOX 604
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-2545
Mailing Address - Country:US
Mailing Address - Phone:989-539-2900
Mailing Address - Fax:989-368-1304
Practice Address - Street 1:182 N 2ND ST # 604
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-2545
Practice Address - Country:US
Practice Address - Phone:989-539-2900
Practice Address - Fax:989-368-1304
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist