Provider Demographics
NPI:1316959133
Name:BOWERSOX, GEORGE L (RPH,CDM)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:BOWERSOX
Suffix:
Gender:M
Credentials:RPH,CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3305
Mailing Address - Country:US
Mailing Address - Phone:603-880-6461
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4635
Practice Address - Country:US
Practice Address - Phone:603-579-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist