Provider Demographics
NPI:1699454694
Name:GOWER, BROOKE NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:GOWER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 STATE ROUTE 274
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9505
Mailing Address - Country:US
Mailing Address - Phone:937-423-2533
Mailing Address - Fax:
Practice Address - Street 1:1501 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2763
Practice Address - Country:US
Practice Address - Phone:937-547-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist