Basic Information
| Provider Information | |||||||||
| NPI: | 1366675449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOWER | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12419 E 90TH ST N | ||||||||
| Address2: | |||||||||
| City: | OWASSO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740552036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185881900 | ||||||||
| FaxNumber: | 9185826405 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S PEORIA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741203820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185881900 | ||||||||
| FaxNumber: | 9185826405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11342 | OK | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.