Organization
FOWLERVILLE RX LLC
Active
Other names
FOWLERVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISHNA KANDAGATLA (MEMBER)
(517) 316-6716
Entity
Organization
Contact information
Practice address
119 E GRAND RIVER AVE, FOWLERVILLE, MI 48836
(517) 223-9832
(517) 223-7267
Mailing address
119 E GRAND RIVER AVE, FOWLERVILLE, MI 48836
(517) 223-9832
(517) 223-7267
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301004232
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2339100
—
MI
Enumeration date
08/07/2006
Last updated
11/14/2023
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