Provider Demographics
NPI:1629217716
Name:BOWEN PHARMACY INC
Entity Type:Organization
Organization Name:BOWEN PHARMACY INC
Other - Org Name:BOWEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-956-9111
Mailing Address - Street 1:826 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5029
Mailing Address - Country:US
Mailing Address - Phone:212-956-9111
Mailing Address - Fax:212-956-9112
Practice Address - Street 1:826 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5029
Practice Address - Country:US
Practice Address - Phone:212-956-9111
Practice Address - Fax:212-956-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0291763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03091949Medicaid
3360081OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY3091949Medicaid