Provider Demographics
NPI:1356477871
Name:BOWDEN, ROSEANNA LOU (RPH TEXAS 23029)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANNA
Middle Name:LOU
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:RPH TEXAS 23029
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MONTGOMERY ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450
Mailing Address - Country:US
Mailing Address - Phone:940-549-8360
Mailing Address - Fax:940-549-8361
Practice Address - Street 1:814 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450
Practice Address - Country:US
Practice Address - Phone:940-549-8360
Practice Address - Fax:940-549-8361
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143046Medicaid