Kermit Kim Cowley, RPH
Individual provider Active NPI Pharmacist · Eden, UT
NPI 1396862801 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1396862801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 346546-1701 (UT)
- Practice address
- 2555 N. Wolf Creek Drive
Eden, UT 84310 - Phone
- (801) 745-1800
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 346546-1701 | UT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roe RX Inc | Past | Accepting new patients | |
| Elite Mus Holdings LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 346546-1701 | UT | Yes |
Addresses
Primary practice location
2555 N. Wolf Creek Drive
Eden, UT 84310
Mailing address
1930 Deer Run Dr
South Weber, UT 84405-9235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 136546-1701 | Other | UT | UTAH PHARMACY LICENSE |
Other providers in Eden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.