Provider Demographics
NPI:1972623742
Name:BOWERS, CARNEICE LATRELL
Entity Type:Individual
Prefix:MRS
First Name:CARNEICE
Middle Name:LATRELL
Last Name:BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARNEICE
Other - Middle Name:LATRELLL
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2163
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32644
Mailing Address - Country:US
Mailing Address - Phone:352-490-8122
Mailing Address - Fax:352-490-7711
Practice Address - Street 1:2202 N YOUNG BLVD
Practice Address - Street 2:#300
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626
Practice Address - Country:US
Practice Address - Phone:352-493-7447
Practice Address - Fax:352-490-7711
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2401010215576183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician