Provider Demographics
NPI:1992926331
Name:GOWAN, BOBBYE CAROL (BS, PHARMD, CDM)
Entity type:Individual
Prefix:
First Name:BOBBYE
Middle Name:CAROL
Last Name:GOWAN
Suffix:
Gender:F
Credentials:BS, PHARMD, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4008
Mailing Address - Country:US
Mailing Address - Phone:580-622-2144
Mailing Address - Fax:580-622-6486
Practice Address - Street 1:1211 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4008
Practice Address - Country:US
Practice Address - Phone:580-622-2144
Practice Address - Fax:580-622-6486
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist