Provider Demographics
NPI:1396182499
Name:MOWRY, STEPHEN SCOTT
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:MOWRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AMANDA WAY
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6266
Mailing Address - Country:US
Mailing Address - Phone:978-532-4378
Mailing Address - Fax:
Practice Address - Street 1:21 JOYCE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3636
Practice Address - Country:US
Practice Address - Phone:781-593-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH17647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist