Provider Demographics
NPI:1639519184
Name:FOWLER, TONY W (PD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:W
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 LAUREN DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8476
Mailing Address - Country:US
Mailing Address - Phone:501-772-9651
Mailing Address - Fax:501-279-7782
Practice Address - Street 1:1540 RACE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8476
Practice Address - Country:US
Practice Address - Phone:501-268-5315
Practice Address - Fax:501-279-7782
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist