Provider Demographics
NPI:1316013568
Name:LOWERS PHARMACY INC
Entity Type:Organization
Organization Name:LOWERS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:MOBUS
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-652-5633
Mailing Address - Street 1:33 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1257
Mailing Address - Country:US
Mailing Address - Phone:814-652-5633
Mailing Address - Fax:
Practice Address - Street 1:33 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1257
Practice Address - Country:US
Practice Address - Phone:814-652-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412869L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010120420001Medicaid
PA3911179OtherNCPDP NUMBER
PA0753860001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER