MEDICARE: DR. JERMAINE BOWEN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39268	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PU6512	FL

General Provider Information

NPI Number	:	1336410232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERMAINE BOWEN PHARM.D.

Provider Business Mailing Address
First Line	:	16411 SW 28TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5209
Country	:	US
Telephone Number	:	954-324-7447
Fax Number	:	954-342-1820

Provider Business Practice Location Address
First Line	:	16 NW 26TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5106
Country	:	US
Telephone Number	:	305-642-5600
Fax Number	:	305-642-5699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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