Healthcare Provider Details

I. General information

NPI: 1972939015
Provider Name (Legal Business Name): J & M BOWLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MT WILLIAMS DR
NORMAN OK
73069
US

IV. Provider business mailing address

820 WEST DANFORTH ROAD #A4
EDMOND OK
73003
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-8145
  • Fax: 405-563-9382
Mailing address:
  • Phone: 405-809-8145
  • Fax: 405-563-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7-8059
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7-6410
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY MICHAEL BOWLES
Title or Position: PHARMACIST/OWNER
Credential: DPH
Phone: 405-809-8145