Provider Demographics
NPI:1154684124
Name:COWAN, KATHRYN DIANNE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANNE
Last Name:COWAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22951 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2604
Mailing Address - Country:US
Mailing Address - Phone:951-965-6921
Mailing Address - Fax:951-242-0348
Practice Address - Street 1:22951 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2604
Practice Address - Country:US
Practice Address - Phone:951-965-6921
Practice Address - Fax:951-242-0348
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist