Provider Demographics
NPI:1093845703
Name:SHOWALTER, LOWELL R
Entity Type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:R
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LOWELL
Other - Middle Name:R
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSPHARM
Mailing Address - Street 1:6806 WELLESLEY TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2768
Mailing Address - Country:US
Mailing Address - Phone:248-623-4950
Mailing Address - Fax:
Practice Address - Street 1:3415 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3009
Practice Address - Country:US
Practice Address - Phone:248-682-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032285183500000X
MI4401002888227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered