Provider Demographics
NPI:1336512649
Name:BOWMAN, KENNETH EARL
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EARL
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 RAGWEED ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4108
Mailing Address - Country:US
Mailing Address - Phone:858-484-6598
Mailing Address - Fax:858-484-6598
Practice Address - Street 1:12358 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4219
Practice Address - Country:US
Practice Address - Phone:858-748-9220
Practice Address - Fax:858-748-5180
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7525183500000X
CA350201835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist