Provider Demographics
NPI:1952682478
Name:GOWER, DAVID TRYON (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TRYON
Last Name:GOWER
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 1:1361 EVERETT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-4558
Mailing Address - Country:US
Mailing Address - Phone:770-546-4206
Mailing Address - Fax:
Practice Address - Street 1:701 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1637
Practice Address - Country:US
Practice Address - Phone:706-295-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist