Provider Demographics
NPI:1528385069
Name:BOWEN, EATHEL L (RPH)
Entity Type:Individual
Prefix:
First Name:EATHEL
Middle Name:L
Last Name:BOWEN
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 1:120 HIGHWAY 14
Mailing Address - Street 2:BI-LO PHARMACY
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6056
Mailing Address - Country:US
Mailing Address - Phone:864-967-9029
Mailing Address - Fax:864-967-9054
Practice Address - Street 1:120 HIGHWAY 14
Practice Address - Street 2:BI-LO PHARMACY
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6056
Practice Address - Country:US
Practice Address - Phone:864-967-9029
Practice Address - Fax:864-967-9054
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC006588OtherSTATE PHARMACY LICENSE