Provider Demographics
NPI:1962177246
Name:LOEWEN, MIRIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:LOEWEN
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 1:5791 JUDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1203
Mailing Address - Country:US
Mailing Address - Phone:309-278-2995
Mailing Address - Fax:
Practice Address - Street 1:2002 SPRUCE HILLS DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2627
Practice Address - Country:US
Practice Address - Phone:563-359-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist