Provider Demographics
NPI:1942396619
Name:COWAN, RICHARD E (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:COWAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:511 AUTUMN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5990
Mailing Address - Country:US
Mailing Address - Phone:636-256-2974
Mailing Address - Fax:
Practice Address - Street 1:2295 PARKLAKE DR NE
Practice Address - Street 2:BUILDING 12, SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2801
Practice Address - Country:US
Practice Address - Phone:770-986-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09136183500000X
MO028397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist