Provider Demographics
NPI:1760066039
Name:OW, GARRETT (PHARMD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:OW
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 1:617 W FOOTHILL BLVD UNIT 67
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2488
Mailing Address - Country:US
Mailing Address - Phone:626-831-8168
Mailing Address - Fax:
Practice Address - Street 1:1719 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1611
Practice Address - Country:US
Practice Address - Phone:626-798-6789
Practice Address - Fax:626-798-8376
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH61893OtherPHARMACISTS LICENSE