Provider Demographics
NPI:1679399398
Name:SHARP-BOWMAN, TADD EVAN
Entity type:Individual
Prefix:
First Name:TADD
Middle Name:EVAN
Last Name:SHARP-BOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 LAWRENCE LN # 8
Mailing Address - Street 2:
Mailing Address - City:PORCUPINE
Mailing Address - State:SD
Mailing Address - Zip Code:57772-3064
Mailing Address - Country:US
Mailing Address - Phone:605-407-0138
Mailing Address - Fax:
Practice Address - Street 1:1883 LAWRENCE LN # 8
Practice Address - Street 2:
Practice Address - City:PORCUPINE
Practice Address - State:SD
Practice Address - Zip Code:57772-3064
Practice Address - Country:US
Practice Address - Phone:605-407-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy