Provider Demographics
NPI:1275115693
Name:BOWERSOX, PAULA SUE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:BOWERSOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 ROAD 151
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9716
Mailing Address - Country:US
Mailing Address - Phone:419-594-2923
Mailing Address - Fax:
Practice Address - Street 1:1000 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1076
Practice Address - Country:US
Practice Address - Phone:419-399-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09200421183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician