Healthcare Provider Details

I. General information

NPI: 1679200349
Provider Name (Legal Business Name): TIMOTHY PAUL BOWDEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 900 E STE 150
SALT LAKE CITY UT
84102-2959
US

IV. Provider business mailing address

4029 LILY DR
ROY UT
84067-9609
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-9500
  • Fax: 801-679-4748
Mailing address:
  • Phone: 801-698-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5739117-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: