Provider Demographics
NPI:1477253201
Name:BOWEN, KYLE ANGELO
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANGELO
Last Name:BOWEN
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 1:6423 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5520
Mailing Address - Country:US
Mailing Address - Phone:718-567-0890
Mailing Address - Fax:718-567-0968
Practice Address - Street 1:6423 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5520
Practice Address - Country:US
Practice Address - Phone:718-567-0890
Practice Address - Fax:718-567-0968
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004466183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician