Provider Demographics
NPI:1417532490
Name:BOWDEN, VAN A (RPH)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:A
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 IRVIN COBB DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-2196
Mailing Address - Country:US
Mailing Address - Phone:270-442-6404
Mailing Address - Fax:
Practice Address - Street 1:3220 IRVIN COBB DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0337
Practice Address - Country:US
Practice Address - Phone:270-442-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist