Provider Demographics
NPI:1821312588
Name:BOWEN, DWIGHT ALBEN JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ALBEN
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 STONE HEDGE CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7379
Mailing Address - Country:US
Mailing Address - Phone:901-299-5277
Mailing Address - Fax:
Practice Address - Street 1:936 STONE HEDGE CV
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7379
Practice Address - Country:US
Practice Address - Phone:901-299-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X, 390200000X
IN26024390A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program