Healthcare Provider Details

I. General information

NPI: 1114698990
Provider Name (Legal Business Name): MIKAL BOWMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 W KEARNEY ST STE 116
SPRINGFIELD MO
65803-2055
US

IV. Provider business mailing address

653 S HAZELNUT AVE
SPRINGFIELD MO
65802-5648
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-1547
  • Fax:
Mailing address:
  • Phone: 417-437-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021033952
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: