Basic Information
| Provider Information | |||||||||
| NPI: | 1548813801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWLES | ||||||||
| FirstName: | RAELEE | ||||||||
| MiddleName: | JOANNA | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 N MURRAY CT | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672124216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162096368 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10222 W 21ST ST N | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672051836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167291535 | ||||||||
| FaxNumber: | 3167291538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2019 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1-109375 | KS | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.