Provider Demographics
NPI:1396355962
Name:BOWERS, CONNOR EDWARD (RPH)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:EDWARD
Last Name:BOWERS
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 1:9700 CISCO RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-7346
Mailing Address - Country:US
Mailing Address - Phone:937-266-0950
Mailing Address - Fax:
Practice Address - Street 1:525 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1599
Practice Address - Country:US
Practice Address - Phone:419-772-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist