Provider Demographics
NPI:1649672171
Name:MCINTOSH, OWEN LOUIS
Entity type:Individual
Prefix:MR
First Name:OWEN
Middle Name:LOUIS
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N GENERALS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3557
Mailing Address - Country:US
Mailing Address - Phone:704-732-3095
Mailing Address - Fax:704-732-3097
Practice Address - Street 1:306 N GENERALS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3557
Practice Address - Country:US
Practice Address - Phone:704-732-3095
Practice Address - Fax:704-732-3097
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist