Provider Demographics
NPI:1730507542
Name:BOWLING, JEREMY TODD (PHARMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:TODD
Last Name:BOWLING
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 1:581 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-9082
Mailing Address - Country:US
Mailing Address - Phone:606-287-4719
Mailing Address - Fax:606-287-7822
Practice Address - Street 1:581 MAIN ST N
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447-9082
Practice Address - Country:US
Practice Address - Phone:606-287-4719
Practice Address - Fax:606-287-7822
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist