Provider Demographics
NPI:1376883272
Name:BOWEN, TRACY A (RPH)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:BOWEN-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:10710 RESEARCH BLVD
Mailing Address - Street 2:200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5798
Mailing Address - Country:US
Mailing Address - Phone:512-794-8324
Mailing Address - Fax:
Practice Address - Street 1:10710 RESEARCH BLVD
Practice Address - Street 2:200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5798
Practice Address - Country:US
Practice Address - Phone:512-794-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist