Provider Demographics
NPI:1447536438
Name:HORTON, LOWELL THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:THOMAS
Last Name:HORTON
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 1:5056 DOVE CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7515
Mailing Address - Country:US
Mailing Address - Phone:563-340-9667
Mailing Address - Fax:
Practice Address - Street 1:3100 11TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-6706
Practice Address - Country:US
Practice Address - Phone:309-786-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035026183500000X
IA16581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist