Provider Demographics
NPI:1578279048
Name:FOWERS, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:FOWERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2240
Mailing Address - Country:US
Mailing Address - Phone:801-782-6116
Mailing Address - Fax:801-782-7222
Practice Address - Street 1:2645 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2240
Practice Address - Country:US
Practice Address - Phone:801-782-6116
Practice Address - Fax:801-782-7222
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7426510-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist