Provider Demographics
NPI:1366725202
Name:BOWLES, HERBERT JR (RPH)
Entity type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:
Last Name:BOWLES
Suffix:JR
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 1:11015 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3533
Mailing Address - Country:US
Mailing Address - Phone:314-849-3938
Mailing Address - Fax:
Practice Address - Street 1:3822 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1817
Practice Address - Country:US
Practice Address - Phone:314-773-1384
Practice Address - Fax:314-773-1971
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist