Provider Demographics
NPI:1588962146
Name:LOWERY, JAMES KENNETH
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:LOWERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 BLUETICK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5119
Mailing Address - Country:US
Mailing Address - Phone:919-630-5303
Mailing Address - Fax:
Practice Address - Street 1:7505 LOUISBUG RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-876-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC183500000XOtherPHARMACIST