Provider Demographics
NPI:1568070563
Name:ROWLAND, BRADLEY KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KEITH
Last Name:ROWLAND
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 1:157 S JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-0917
Mailing Address - Country:US
Mailing Address - Phone:660-886-5515
Mailing Address - Fax:660-886-2890
Practice Address - Street 1:157 S JEFFERSON
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-0917
Practice Address - Country:US
Practice Address - Phone:660-886-5515
Practice Address - Fax:660-886-2890
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0419881835P2201X
MO041988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care