Provider Demographics
NPI:1093031643
Name:BOWIE, RICHARD MCAULEY (P,D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MCAULEY
Last Name:BOWIE
Suffix:
Gender:M
Credentials:P,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-4454
Mailing Address - Country:US
Mailing Address - Phone:205-221-4090
Mailing Address - Fax:205-295-1521
Practice Address - Street 1:5100 CURRY HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-5865
Practice Address - Country:US
Practice Address - Phone:205-221-4090
Practice Address - Fax:205-295-1521
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001496Medicaid
AL1036870001Medicare NSC