Provider Demographics
NPI:1154921153
Name:GOWER, GALE EUGENE JR (RPH)
Entity type:Individual
Prefix:
First Name:GALE
Middle Name:EUGENE
Last Name:GOWER
Suffix:JR
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 1:1304 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-3729
Mailing Address - Country:US
Mailing Address - Phone:618-544-8522
Mailing Address - Fax:618-544-8796
Practice Address - Street 1:1304 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-3729
Practice Address - Country:US
Practice Address - Phone:618-544-8522
Practice Address - Fax:618-544-8796
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510037458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist