Provider Demographics
NPI:1467058719
Name:BOWEN, RODNEY SHANE (RPH)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:SHANE
Last Name:BOWEN
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 1:9948 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9555
Mailing Address - Country:US
Mailing Address - Phone:251-639-1788
Mailing Address - Fax:251-639-1844
Practice Address - Street 1:9948 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9555
Practice Address - Country:US
Practice Address - Phone:251-639-1788
Practice Address - Fax:251-639-1844
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist