Provider Demographics
NPI:1023372489
Name:DOW, ALEX CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:CHARLES
Last Name:DOW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SUMMIT RDG
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6477
Mailing Address - Country:US
Mailing Address - Phone:618-977-5732
Mailing Address - Fax:
Practice Address - Street 1:4701 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3416
Practice Address - Country:US
Practice Address - Phone:618-310-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist