Provider Demographics
NPI:1104110154
Name:LOWER, AMY MARIE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 RESEARCH BLVD
Mailing Address - Street 2:T-2409
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5803
Mailing Address - Country:US
Mailing Address - Phone:512-687-1316
Mailing Address - Fax:512-687-1326
Practice Address - Street 1:10107 RESEARCH BLVD
Practice Address - Street 2:T-2409
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5803
Practice Address - Country:US
Practice Address - Phone:512-687-1316
Practice Address - Fax:512-687-1326
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45753183500000X
NE10911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist