Individual
DEREK LESTER MCCOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16410 WISE STREET, ST. PAUL, VA 24283
(276) 762-4009
(276) 762-8113
Mailing address
PO BOX 306, SAINT PAUL, VA 24283-0306
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202219948
VA
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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