MEDICARE: DR. DWIGHT ALBEN BOWEN JR. 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	183700000X	Pharmacy Technician
2	390200000X	Student in an Organized Health Care Education/Training Program
3	183500000X	Pharmacist	26024390A	IN

General Provider Information

NPI Number	:	1821312588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT ALBEN BOWEN JR. PHARM.D.

Provider Business Mailing Address
First Line	:	936 STONE HEDGE CV
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7379
Country	:	US
Telephone Number	:	901-299-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 STONE HEDGE CV
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7379
Country	:	US
Telephone Number	:	901-299-5277
Fax Number	:

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

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	03/29/2012

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