Provider Demographics
NPI:1144313586
Name:BOWIE PHARMACY INC
Entity type:Organization
Organization Name:BOWIE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULE KORKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-860-0800
Mailing Address - Street 1:14999 HEALTH CENTER DR
Mailing Address - Street 2:STE 201
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1074
Mailing Address - Country:US
Mailing Address - Phone:410-860-0800
Mailing Address - Fax:410-860-1301
Practice Address - Street 1:14999 HEALTH CENTER DR
Practice Address - Street 2:STE 201
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1074
Practice Address - Country:US
Practice Address - Phone:410-860-0800
Practice Address - Fax:410-860-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP025673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125169OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD101101400Medicaid