Individual
JACOB BOWERSOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 N KARWICK RD, MICHIGAN CITY, IN 46360-2191
(219) 872-6811
Mailing address
2117 KELLE DR APT 104, CHESTERTON, IN 46304-8986
(419) 204-9672
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26024687A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26024687A
PHARMACIST
IN
Enumeration date
11/23/2020
Last updated
11/23/2020
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