Provider Demographics
NPI:1043239510
Name:ROWE, JEFFREY MARK (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:ROWE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 N MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1911
Mailing Address - Country:US
Mailing Address - Phone:810-659-2423
Mailing Address - Fax:810-732-2580
Practice Address - Street 1:G3320 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3614
Practice Address - Country:US
Practice Address - Phone:810-732-8720
Practice Address - Fax:810-732-2580
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020240691835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024069OtherSTATE LICENSE