Provider Demographics
NPI:1760003388
Name:CHARRY BOWEN, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:CHARRY BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 UNIVERSITY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5518
Mailing Address - Country:US
Mailing Address - Phone:813-632-6200
Mailing Address - Fax:
Practice Address - Street 1:2232 UNIVERSITY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5518
Practice Address - Country:US
Practice Address - Phone:813-632-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist