Provider Demographics
NPI:1275844417
Name:BOWERS, STACY GOSE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:GOSE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7971 RHEA COUNTY HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5924
Mailing Address - Country:US
Mailing Address - Phone:423-775-2163
Mailing Address - Fax:423-775-5938
Practice Address - Street 1:7971 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5924
Practice Address - Country:US
Practice Address - Phone:423-775-2163
Practice Address - Fax:423-775-5938
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN7641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist