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General NPI Number Information
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NPI Number | 1124752985
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Entity Type | Individual
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Provider Name | ANDREW GUNNAR BOWERSOCK PHARMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 460 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 800-293-5066
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 EBERTON AVE
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City | BLACKLICK
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State | OH
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Zip | 43004-7095
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Country | US
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Telephone | 614-361-6569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03442209
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License Number State | OH
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