Provider Demographics
NPI:1780921965
Name:BOWEN, JIM (RPH)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:BOWEN
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 1:762 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5639
Mailing Address - Country:US
Mailing Address - Phone:954-347-0585
Mailing Address - Fax:
Practice Address - Street 1:5500 PARK RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8319
Practice Address - Country:US
Practice Address - Phone:561-369-7900
Practice Address - Fax:561-369-0880
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist