Provider Demographics
NPI:1215369624
Name:BOWEN, KURT ANDREW (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:ANDREW
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 SR 23
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:WA
Mailing Address - Zip Code:99171-9777
Mailing Address - Country:US
Mailing Address - Phone:509-993-4378
Mailing Address - Fax:
Practice Address - Street 1:11325 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5070
Practice Address - Country:US
Practice Address - Phone:360-253-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60341010183500000X
ORRPH-0013650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist