# FOWLERVILLE RX LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FOWLERVILLE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932968740
- **Authorized official:** KRISHNA KANDAGATLA (OWNER)
- **Authorized official phone:** (517) 223-9832

## Contact information

- **Practice address:** 119 E GRAND RIVER AVE, FOWLERVILLE, MI 48836-5109
- **Practice address phone:** (517) 223-9832
- **Mailing address:** 119 E GRAND RIVER AVE, FOWLERVILLE, MI 48836-5109
- **Mailing address phone:** (517) 223-9832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/14/2024
- **Last updated:** 03/21/2024