Provider Demographics
NPI:1487738258
Name:BOWLES PHARMACY, INC.
Entity type:Organization
Organization Name:BOWLES PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH, CDM
Authorized Official - Phone:706-647-8267
Mailing Address - Street 1:301 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3636
Mailing Address - Country:US
Mailing Address - Phone:706-647-8267
Mailing Address - Fax:706-647-6526
Practice Address - Street 1:301 N CENTER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3636
Practice Address - Country:US
Practice Address - Phone:706-647-8267
Practice Address - Fax:706-647-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00022019BMedicaid
GA00022019AMedicaid
GA0450420001Medicare NSC