Provider Demographics
NPI:1396079349
Name:BOWKIRK MEDICAL
Entity type:Organization
Organization Name:BOWKIRK MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-269-6129
Mailing Address - Street 1:PO BOX 2928
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-4928
Mailing Address - Country:US
Mailing Address - Phone:606-246-2001
Mailing Address - Fax:606-246-2041
Practice Address - Street 1:3004 CUMBERLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2343
Practice Address - Country:US
Practice Address - Phone:606-246-2001
Practice Address - Fax:606-246-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP073593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831646OtherNCPDP PROVIDER IDENTIFICATION NUMBER