Healthcare Provider Details

I. General information

NPI: 1992583348
Provider Name (Legal Business Name): EMILY ELIZABETH BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH MAIN STREET
STUART VA
24171
US

IV. Provider business mailing address

140 SOUTH MAIN STREET
STUART VA
24171
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4034
  • Fax:
Mailing address:
  • Phone: 276-694-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230040351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: