Provider Demographics
NPI:1790188019
Name:MCCOWEN, BETSY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:MCCOWEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HIGHWAY 61
Mailing Address - Street 2:600 CARROLLTON VILLA RICA HIGHWAY
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4969
Mailing Address - Country:US
Mailing Address - Phone:770-459-9117
Mailing Address - Fax:770-459-8332
Practice Address - Street 1:600 HIGHWAY 61
Practice Address - Street 2:600 CARROLLTON VILLA RICA HIGHWAY
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4969
Practice Address - Country:US
Practice Address - Phone:770-459-9117
Practice Address - Fax:770-459-8332
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist