Provider Demographics
NPI:1659634186
Name:BOWERS, MARY I (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:BOWERS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 SE ENSIGN LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7339
Mailing Address - Country:US
Mailing Address - Phone:503-338-4110
Mailing Address - Fax:503-338-4107
Practice Address - Street 1:1804 SE ENSIGN LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7339
Practice Address - Country:US
Practice Address - Phone:503-338-4110
Practice Address - Fax:503-338-4107
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist