Provider Demographics
NPI:1235732884
Name:TOW, GERALD (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:TOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N ANGLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-1835
Mailing Address - Country:US
Mailing Address - Phone:682-459-2200
Mailing Address - Fax:
Practice Address - Street 1:1601 N ANGLIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-1835
Practice Address - Country:US
Practice Address - Phone:682-459-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist