Provider Demographics
NPI:1386871242
Name:BOWLES, JEREMY WADE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WADE
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 1:1493 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3845
Mailing Address - Country:US
Mailing Address - Phone:931-551-9948
Mailing Address - Fax:931-551-9612
Practice Address - Street 1:1493 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3845
Practice Address - Country:US
Practice Address - Phone:931-551-9948
Practice Address - Fax:931-551-9612
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24501OtherBOARD OF PHARMACY