Provider Demographics
NPI:1891530192
Name:MCGOWEN, KIRK (PHARM D)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:MCGOWEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13432 ROPERS AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OK
Mailing Address - Zip Code:73095-3261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9817
Practice Address - Country:US
Practice Address - Phone:405-485-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist