Provider Demographics
NPI:1922547488
Name:BOWERS, QUERUBIN
Entity Type:Individual
Prefix:
First Name:QUERUBIN
Middle Name:
Last Name:BOWERS
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 1:18600 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4505
Mailing Address - Country:US
Mailing Address - Phone:310-527-4955
Mailing Address - Fax:
Practice Address - Street 1:18600 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4505
Practice Address - Country:US
Practice Address - Phone:310-527-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist