Healthcare Provider Details

I. General information

NPI: 1457760092
Provider Name (Legal Business Name): JENNIFER BOWEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD SUITE 1000
MERIDIAN ID
83642-8364
US

IV. Provider business mailing address

16700 N MARKET PLACE BLVD
NAMPA ID
83687-7909
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5252
  • Fax: 208-706-5255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCT1177
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7802
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: