Healthcare Provider Details

I. General information

NPI: 1053800748
Provider Name (Legal Business Name): MELANIE A BOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 VETERANS DR N
HUNTINGDON TN
38344-6202
US

IV. Provider business mailing address

1939 EXCALIBUR TRL
CEDAR GROVE TN
38321-6718
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-2888
  • Fax:
Mailing address:
  • Phone: 901-413-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12082
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: