Provider Demographics
NPI:1750689626
Name:BOWMAN, CLARK CAIOUS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:CAIOUS
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4330
Mailing Address - Country:US
Mailing Address - Phone:704-864-9787
Mailing Address - Fax:704-864-1443
Practice Address - Street 1:110 W GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4330
Practice Address - Country:US
Practice Address - Phone:704-864-9787
Practice Address - Fax:704-864-1443
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist