Provider Demographics
NPI:1801450150
Name:FOWLER, ROBERT MARION (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARION
Last Name:FOWLER
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 1:15 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3303
Mailing Address - Country:US
Mailing Address - Phone:719-469-5158
Mailing Address - Fax:719-384-9609
Practice Address - Street 1:6 CONLEY RD
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-9640
Practice Address - Country:US
Practice Address - Phone:719-384-5954
Practice Address - Fax:719-384-9609
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist