Provider Demographics
NPI:1710273495
Name:BOWMAN, BRENDA LOIS (BRENDA BOWMAN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOIS
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:BRENDA BOWMAN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BRENDA BOWMAN
Mailing Address - Street 1:2800 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1123
Mailing Address - Country:US
Mailing Address - Phone:303-209-0102
Mailing Address - Fax:303-209-0102
Practice Address - Street 1:2800 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1123
Practice Address - Country:US
Practice Address - Phone:303-209-0102
Practice Address - Fax:303-209-0102
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13425183500000X
IN26016897A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist