Provider Demographics
NPI:1164629374
Name:BOWIE, VENITA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VENITA
Middle Name:LYNN
Last Name:BOWIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:VENITA
Other - Middle Name:LYNN
Other - Last Name:BOWIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8419 CHERISSE DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3556
Mailing Address - Country:US
Mailing Address - Phone:210-474-6791
Mailing Address - Fax:210-921-3236
Practice Address - Street 1:8419 CHERISSE DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3556
Practice Address - Country:US
Practice Address - Phone:210-474-6791
Practice Address - Fax:210-921-3236
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512904671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy