Provider Demographics
NPI:1962538710
Name:FOWLER, PETER O III (DPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:O
Last Name:FOWLER
Suffix:III
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 W 470
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-7557
Mailing Address - Country:US
Mailing Address - Phone:918-825-5950
Mailing Address - Fax:918-825-7781
Practice Address - Street 1:1624 N 3RD
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:OK
Practice Address - Zip Code:74350
Practice Address - Country:US
Practice Address - Phone:918-782-9619
Practice Address - Fax:918-782-9615
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist