Provider Demographics
NPI:1063749653
Name:KOWING, TAMMY ELLIOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELLIOTT
Last Name:KOWING
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 1:124 STONEBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2241
Mailing Address - Country:US
Mailing Address - Phone:940-569-3370
Mailing Address - Fax:
Practice Address - Street 1:4600 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1466
Practice Address - Country:US
Practice Address - Phone:940-692-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist