Provider Demographics
NPI:1114929601
Name:FOWLER, DENNIS J (R PH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:FOWLER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BEAVER STREET
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646
Mailing Address - Country:US
Mailing Address - Phone:814-247-9959
Mailing Address - Fax:814-247-8690
Practice Address - Street 1:317 BEAVER STREET
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646
Practice Address - Country:US
Practice Address - Phone:814-247-9959
Practice Address - Fax:814-247-8690
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411885L183500000X
PARP029470L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007854720001Medicaid
PA3939886OtherNCPDP
PA3939886OtherNCPDP