Healthcare Provider Details

I. General information

NPI: 1134263296
Provider Name (Legal Business Name): BOWIE'S PRIORITY CARE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 CURRY HIGHWAY SUITE 150
JASPER AL
35503
US

IV. Provider business mailing address

5100 CURRY HIGHWAY SUITE 150
JASPER AL
35503
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-4090
  • Fax: 205-295-1521
Mailing address:
  • Phone: 205-221-4090
  • Fax: 205-295-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number101698
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number101698
License Number StateAL

VIII. Authorized Official

Name: WILLIAM AUSTIN
Title or Position: DIRECTOR
Credential:
Phone: 888-980-1985