Provider Demographics
NPI:1306183447
Name:FOWLER, NICOLE M (RPH)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3305
Mailing Address - Country:US
Mailing Address - Phone:239-567-1828
Mailing Address - Fax:239-243-9791
Practice Address - Street 1:6700 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3305
Practice Address - Country:US
Practice Address - Phone:239-567-1828
Practice Address - Fax:239-243-9791
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist