Provider Demographics
NPI:1497930341
Name:BOWMAN, JODY I (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:I
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RODEO TRL
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-8599
Mailing Address - Country:US
Mailing Address - Phone:406-683-6269
Mailing Address - Fax:
Practice Address - Street 1:330 RODEO TRL
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-8599
Practice Address - Country:US
Practice Address - Phone:406-683-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist