Provider Demographics
NPI:1013517200
Name:MOWRY, BRAD PEARSON (RPH)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:PEARSON
Last Name:MOWRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3602
Mailing Address - Country:US
Mailing Address - Phone:417-321-5682
Mailing Address - Fax:
Practice Address - Street 1:2250 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-4258
Practice Address - Country:US
Practice Address - Phone:417-667-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist