Provider Demographics
NPI:1487077954
Name:LOWRY-HEATHER, MICHELLE (RPH, CGP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LOWRY-HEATHER
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 HYATT AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-1433
Mailing Address - Country:US
Mailing Address - Phone:330-933-0310
Mailing Address - Fax:
Practice Address - Street 1:4061 HYATT AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-1433
Practice Address - Country:US
Practice Address - Phone:330-933-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist