Provider Demographics
NPI:1891325064
Name:FOWLER, JAROD HAMILTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAROD
Middle Name:HAMILTON
Last Name:FOWLER
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 1:1719 SORENSON DR APT 201
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3457
Mailing Address - Country:US
Mailing Address - Phone:512-230-7771
Mailing Address - Fax:
Practice Address - Street 1:1719 SORENSON DR APT 201
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3457
Practice Address - Country:US
Practice Address - Phone:512-230-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist