Provider Demographics
NPI:1760784557
Name:BOWLEN, MELANIE JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEAN
Last Name:BOWLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14853 SE POMFRET RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5400
Mailing Address - Country:US
Mailing Address - Phone:971-322-4569
Mailing Address - Fax:
Practice Address - Street 1:1541 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6721
Practice Address - Country:US
Practice Address - Phone:503-665-2565
Practice Address - Fax:503-665-3307
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist