Provider Demographics
NPI:1073805693
Name:COWART, JENNIFER JONES (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JONES
Last Name:COWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3175
Mailing Address - Country:US
Mailing Address - Phone:803-279-1610
Mailing Address - Fax:
Practice Address - Street 1:401 MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3175
Practice Address - Country:US
Practice Address - Phone:803-279-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025580183500000X
SC13014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist