Provider Demographics
NPI:1952520801
Name:LOWERY, LEON HERCHEL (RPH)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:HERCHEL
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 1:1220 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3642
Mailing Address - Country:US
Mailing Address - Phone:972-747-7144
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:710
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-276-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19443OtherTEXAS RPH LICENSE