Provider Demographics
NPI:1891072708
Name:BOWMAN, TIFFANY BURNEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:BURNEY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 BRISTOLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-9271
Mailing Address - Country:US
Mailing Address - Phone:252-758-1662
Mailing Address - Fax:
Practice Address - Street 1:3040 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3176
Practice Address - Country:US
Practice Address - Phone:252-756-7393
Practice Address - Fax:252-353-0664
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435553Medicaid