Provider Demographics
NPI:1598822819
Name:GOWER PHARMACY, INC.
Entity Type:Organization
Organization Name:GOWER PHARMACY, INC.
Other - Org Name:MEDSTOP MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARSHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-803-1693
Mailing Address - Street 1:753 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1385
Mailing Address - Country:US
Mailing Address - Phone:502-839-3418
Mailing Address - Fax:502-839-3064
Practice Address - Street 1:753 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1385
Practice Address - Country:US
Practice Address - Phone:502-839-3418
Practice Address - Fax:502-839-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07447333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100167830Medicaid