Provider Demographics
NPI:1285002626
Name:STOWE, SHANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:STOWE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WAITE AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1348
Mailing Address - Country:US
Mailing Address - Phone:320-259-1148
Mailing Address - Fax:320-259-1334
Practice Address - Street 1:113 WAITE AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1348
Practice Address - Country:US
Practice Address - Phone:320-259-1148
Practice Address - Fax:320-259-1334
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist