Provider Demographics
NPI:1487998688
Name:LOWE, JACK RICHARD (RPH)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:RICHARD
Last Name:LOWE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1403
Mailing Address - Country:US
Mailing Address - Phone:843-524-5440
Mailing Address - Fax:
Practice Address - Street 1:1500 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1403
Practice Address - Country:US
Practice Address - Phone:843-524-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist