Provider Demographics
NPI:1225376544
Name:J & M BOWLES LLC
Entity Type:Organization
Organization Name:J & M BOWLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-330-1089
Mailing Address - Street 1:820 WEST DANFORTH ROAD #A4
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003
Mailing Address - Country:US
Mailing Address - Phone:405-330-1089
Mailing Address - Fax:405-330-1092
Practice Address - Street 1:2200 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-330-1089
Practice Address - Fax:405-330-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-6149333600000X
OK7-8058333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200473380AMedicaid