Provider Demographics
NPI:1295010510
Name:BOWEN, DANIEL BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRYAN
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KENO
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:LAPOINT
Mailing Address - State:UT
Mailing Address - Zip Code:84039-0435
Mailing Address - Country:US
Mailing Address - Phone:801-560-8560
Mailing Address - Fax:
Practice Address - Street 1:1316 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4203
Practice Address - Country:US
Practice Address - Phone:435-789-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5656806-1701183500000X
UT5656806-8911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist