Provider Demographics
NPI:1245410273
Name:KOWAL, EVAN ALEXANDER (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:ALEXANDER
Last Name:KOWAL
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:ALEXANDER
Other - Last Name:FLEISCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOCTOR OF PHAMACY
Mailing Address - Street 1:1415 N CLINTON AVE UNIT 11B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3354
Mailing Address - Country:US
Mailing Address - Phone:585-413-3292
Mailing Address - Fax:585-563-6463
Practice Address - Street 1:1415 N CLINTON AVE UNIT 11B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3354
Practice Address - Country:US
Practice Address - Phone:585-413-3292
Practice Address - Fax:585-563-6463
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist