Provider Demographics
NPI:1780974840
Name:LOWERY, MICHAEL A (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LOWERY
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 1:415 EAST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537
Mailing Address - Country:US
Mailing Address - Phone:304-329-2212
Mailing Address - Fax:304-329-3803
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1701
Practice Address - Country:US
Practice Address - Phone:304-329-2212
Practice Address - Fax:304-329-3803
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0005234OtherPHARMACY LICENSE