Provider Demographics
NPI:1538530886
Name:BOWLES, JEREMY MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:BOWLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 SOUTHWEST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107
Mailing Address - Country:US
Mailing Address - Phone:918-986-8644
Mailing Address - Fax:918-986-8655
Practice Address - Street 1:4227 SOUTHWEST BOULEVARD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107
Practice Address - Country:US
Practice Address - Phone:918-986-8644
Practice Address - Fax:918-986-8655
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OK15443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy