Provider Demographics
NPI:1295034676
Name:BOWEN, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 FLORIDA MINING BLVD W
Mailing Address - Street 2:SUITE 411
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2031
Mailing Address - Country:US
Mailing Address - Phone:904-652-1990
Mailing Address - Fax:904-652-1991
Practice Address - Street 1:9655 FLORIDA MINING BLVD W
Practice Address - Street 2:SUITE 411
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2031
Practice Address - Country:US
Practice Address - Phone:904-652-1990
Practice Address - Fax:904-652-1991
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS424301835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist