Provider Demographics
NPI:1558952341
Name:COWGER, KRISTI MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:MICHELLE
Last Name:COWGER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 WHISKEY CHUTE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7696
Mailing Address - Country:US
Mailing Address - Phone:501-730-4075
Mailing Address - Fax:501-327-8939
Practice Address - Street 1:1014 HARKRIDER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4472
Practice Address - Country:US
Practice Address - Phone:501-327-6777
Practice Address - Fax:501-327-8939
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131853716Medicaid