Provider Demographics
NPI:1790389260
Name:FOWLER, MELINDA CARGILE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:CARGILE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:59 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-2075
Mailing Address - Country:US
Mailing Address - Phone:229-412-2333
Mailing Address - Fax:
Practice Address - Street 1:1948 OLD OCILLA RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1644
Practice Address - Country:US
Practice Address - Phone:229-391-3500
Practice Address - Fax:229-391-3499
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist