Provider Demographics
NPI:1073790069
Name:BOWMER, JERALD E (RPH)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:E
Last Name:BOWMER
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 1:17301 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-8046
Mailing Address - Country:US
Mailing Address - Phone:913-530-1493
Mailing Address - Fax:913-599-5435
Practice Address - Street 1:17301 W 84TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-8046
Practice Address - Country:US
Practice Address - Phone:913-530-1493
Practice Address - Fax:913-599-5435
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003001219183500000X
TX18762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist