Healthcare Provider Details

I. General information

NPI: 1083228282
Provider Name (Legal Business Name): LARRY BOWMAN JR. PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MEDICAL GROUP UNIT 3215
APO AE
09094
US

IV. Provider business mailing address

411 OAK ST
CINCINNATI OH
45219-2504
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2542
  • Fax:
Mailing address:
  • Phone: 513-984-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03136240
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: