Provider Demographics
NPI:1407999196
Name:MCGOWAN, RICHARD J (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MCGOWAN
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 1:6000 WATERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1318
Mailing Address - Country:US
Mailing Address - Phone:515-255-1039
Mailing Address - Fax:
Practice Address - Street 1:4100 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3533
Practice Address - Country:US
Practice Address - Phone:515-633-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist