Healthcare Provider Details

I. General information

NPI: 1629694146
Provider Name (Legal Business Name): ASHLEY BROOKE BOWMAN PHARMACY STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 CC CAMP RD
ELKIN NC
28621-8704
US

IV. Provider business mailing address

722 W INDEPENDENCE BLVD
MOUNT AIRY NC
27030-3574
US

V. Phone/Fax

Practice location:
  • Phone: 336-526-2640
  • Fax:
Mailing address:
  • Phone: 336-789-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: