Provider Demographics
NPI:1194936526
Name:LOWREY, MARI ELIZABETH III
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:ELIZABETH
Last Name:LOWREY
Suffix:III
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 1:12741 LAUREL ST UNIT 79
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2137
Mailing Address - Country:US
Mailing Address - Phone:619-443-0545
Mailing Address - Fax:
Practice Address - Street 1:12741 LAUREL ST UNIT 79
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2137
Practice Address - Country:US
Practice Address - Phone:619-443-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician