Provider Demographics
NPI:1053145250
Name:FOWLER, JOAN B (PHARMD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:B
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 NEEL LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9158
Mailing Address - Country:US
Mailing Address - Phone:859-492-8172
Mailing Address - Fax:
Practice Address - Street 1:926 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1471
Practice Address - Country:US
Practice Address - Phone:502-868-6027
Practice Address - Fax:502-868-6196
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0105631835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist