Provider Demographics
NPI:1710002803
Name:BOWLES PHARMACY INC
Entity Type:Organization
Organization Name:BOWLES PHARMACY INC
Other - Org Name:J & M DRUG AT HOMELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-330-1089
Mailing Address - Street 1:820 W DANFORTH RD # A4
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5006
Mailing Address - Country:US
Mailing Address - Phone:918-369-9411
Mailing Address - Fax:918-336-7099
Practice Address - Street 1:811 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4025
Practice Address - Country:US
Practice Address - Phone:918-336-9411
Practice Address - Fax:918-336-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
OK9-81133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176554OtherPK
OK1100247620AMedicaid
3713612OtherOTHER ID NUMBER-COMMERCIAL NUMBER