Provider Demographics
NPI:1205847159
Name:STOWERS, MICHAEL D (DPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:STOWERS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-4844
Mailing Address - Country:US
Mailing Address - Phone:580-832-3960
Mailing Address - Fax:
Practice Address - Street 1:1213 N GLENN L ENGLISH ST
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-2009
Practice Address - Country:US
Practice Address - Phone:580-832-3714
Practice Address - Fax:580-832-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK33-3415OtherOK BOARD OF PHARMACY
OKBC1811670OtherDEA NUMBER