1134621956 NPI number — CANDACE JERNIGAN BOWMAN PHARMD

Table of content: CANDACE JERNIGAN BOWMAN PHARMD (NPI 1134621956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134621956 NPI number — CANDACE JERNIGAN BOWMAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
CANDACE
Provider Middle Name:
JERNIGAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JERNIGAN
Provider Other First Name:
CANDACE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134621956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 SAINT ANDREWS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37128-6023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-427-2162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2478 NEW SALEM HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37128-5248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-546-6968
Provider Business Practice Location Address Fax Number:
615-546-6967
Provider Enumeration Date:
03/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  39132 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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