Healthcare Provider Details

I. General information

NPI: 1306108212
Provider Name (Legal Business Name): KEVIN E. BOWMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SMALLACOMBE DR SUITE#1
SCRANTON PA
18508-2616
US

IV. Provider business mailing address

201 SMALLACOMBE DR SUITE#1
SCRANTON PA
18508-2616
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-6450
  • Fax:
Mailing address:
  • Phone: 570-340-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP-029939L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: