Provider Demographics
NPI:1700208675
Name:BOWMAN, HERBERT BRUCE (RPH)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:BRUCE
Last Name:BOWMAN
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 1:3621 MARY ELLEN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4803
Mailing Address - Country:US
Mailing Address - Phone:505-688-3389
Mailing Address - Fax:
Practice Address - Street 1:3621 MARY ELLEN ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4803
Practice Address - Country:US
Practice Address - Phone:505-688-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM004140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist