Provider Demographics
NPI:1639488281
Name:BOWLES, JACK L (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:L
Last Name:BOWLES
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 1:813 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2824
Mailing Address - Country:US
Mailing Address - Phone:622-455-3527
Mailing Address - Fax:662-455-2142
Practice Address - Street 1:813 W PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2824
Practice Address - Country:US
Practice Address - Phone:662-455-3527
Practice Address - Fax:662-455-2142
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD6812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist