Provider Demographics
NPI:1265873053
Name:VOWELL, MICHAEL CARLILE (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARLILE
Last Name:VOWELL
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 1:3840 S 103RD EAST AVE
Mailing Address - Street 2:SUITE 234
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2438
Mailing Address - Country:US
Mailing Address - Phone:918-660-0576
Mailing Address - Fax:
Practice Address - Street 1:3840 S 103RD EAST AVE
Practice Address - Street 2:SUITE 234
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2438
Practice Address - Country:US
Practice Address - Phone:918-660-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist