Healthcare Provider Details

I. General information

NPI: 1821312588
Provider Name (Legal Business Name): DWIGHT ALBEN BOWEN JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 STONE HEDGE CV
COLLIERVILLE TN
38017-7379
US

IV. Provider business mailing address

936 STONE HEDGE CV
COLLIERVILLE TN
38017-7379
US

V. Phone/Fax

Practice location:
  • Phone: 901-299-5277
  • Fax:
Mailing address:
  • Phone: 901-299-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26024390A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: