Provider Demographics
NPI:1013047059
Name:WITT-ROWLEY, JEAN ROSE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ROSE
Last Name:WITT-ROWLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S GEECK RD
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-9550
Mailing Address - Country:US
Mailing Address - Phone:989-743-5893
Mailing Address - Fax:
Practice Address - Street 1:221 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1165
Practice Address - Country:US
Practice Address - Phone:989-288-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI026151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI026151OtherMI BOARD OF PHARMACY