Healthcare Provider Details

I. General information

NPI: 1700208675
Provider Name (Legal Business Name): HERBERT BRUCE BOWMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 MARY ELLEN ST NE
ALBUQUERQUE NM
87111-4803
US

IV. Provider business mailing address

3621 MARY ELLEN ST NE
ALBUQUERQUE NM
87111-4803
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-3389
  • Fax:
Mailing address:
  • Phone: 505-688-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: