Provider Demographics
NPI:1932702313
Name:MOWERY, BRIAN LEE (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:MOWERY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BARB CT
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4801
Mailing Address - Country:US
Mailing Address - Phone:540-664-6410
Mailing Address - Fax:
Practice Address - Street 1:800 JOHN MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4577
Practice Address - Country:US
Practice Address - Phone:540-635-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty