Individual
KERMIT KIM COWLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2555 N. WOLF CREEK DRIVE, EDEN, UT 84310
(801) 745-1800
Mailing address
1930 DEER RUN DR, SOUTH WEBER, UT 84405-9235
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
346546-1701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136546-1701
UTAH PHARMACY LICENSE
UT
Enumeration date
03/22/2007
Last updated
07/08/2007
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