Provider Demographics
NPI:1891008082
Name:BOWERS, GARY LYNN
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 MEADOWRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4194
Mailing Address - Country:US
Mailing Address - Phone:610-454-0355
Mailing Address - Fax:215-412-7421
Practice Address - Street 1:1856 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1118
Practice Address - Country:US
Practice Address - Phone:215-412-9375
Practice Address - Fax:215-412-7421
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027213L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist