Provider Demographics
NPI:1275635922
Name:FOWLER, ROGER E (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:E
Last Name:FOWLER
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 1:1138 PAULINE ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-9040
Mailing Address - Country:US
Mailing Address - Phone:850-968-0334
Mailing Address - Fax:
Practice Address - Street 1:312 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-2737
Practice Address - Country:US
Practice Address - Phone:850-478-1126
Practice Address - Fax:850-478-1095
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1085819OtherNABP