Provider Demographics
NPI:1275749103
Name:TURNBOW, BRYAN T (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:T
Last Name:TURNBOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-3601
Mailing Address - Country:US
Mailing Address - Phone:505-521-7001
Mailing Address - Fax:
Practice Address - Street 1:1301 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5804
Practice Address - Country:US
Practice Address - Phone:505-437-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist