Healthcare Provider Details

I. General information

NPI: 1871831545
Provider Name (Legal Business Name): DIANA FRANCES BOWLES PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12134 S DIXIE HWY
SONORA KY
42776-9739
US

IV. Provider business mailing address

12134 S DIXIE HWY
SONORA KY
42776-9739
US

V. Phone/Fax

Practice location:
  • Phone: 270-949-3494
  • Fax: 270-949-3494
Mailing address:
  • Phone: 270-949-3494
  • Fax: 270-949-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8510
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: