Cowan Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010400 Issued in GA

Legal business name

COWAN PHARMACY LLC

Doing business as

Conyers Pharmacy

Practice address

1179 West Ave SW
Conyers, GA 30012-5280

Phone

(770) 929-1414

Fax

(770) 929-3002

NPI assigned

Aug 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adam Mitcham

Title

President

Phone

(770) 929-1414

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Conyers Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Conyers Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Cowan Pharmacy LLC

  dba Conyers Pharmacy

  • Community/Retail Pharmacy
  • Conyers, GA
  • NPI 1558875294
  NPD tax ID
• Cowan Pharmacy LLC

  dba Conyers Pharmacy

  • Long Term Care Pharmacy
  • Conyers, GA
  • NPI 1669191565
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1073521845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 WEST AVE SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300125280",
            "telephone_number": "770-929-1414",
            "fax_number": "770-929-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 WEST AVE SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300125280",
            "telephone_number": "770-929-1414",
            "fax_number": "770-929-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWAN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "MITCHAM",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-929-1414"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003202657A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177325",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conyers Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce Costello, DC
• Donald N Cote, MD
• Christopher Blake Couey, PA
• Covenant Consulting and Practice Management Corp (Covenant Care)
• Brigioni Covington, RBT
• Cowan Pharmacy LLC (Conyers Pharmacy)
• Cowan Pharmacy LLC (Conyers Pharmacy)
• Timothy Neil Cowthorn, D.O.
• Maria Elena Cox, NURSE PRACTITIONER
• Taurasa Chanel Cox, A.S.

• Community/Retail Pharmacy in Conyers, GA
• Providers in Conyers, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.