MEDICARE: MS. LORRE BONNER RPH

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	183500000X	Pharmacist	10044	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	303189	OTHER	NC	NABP

General Provider Information

NPI Number	:	1467983650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORRE BONNER RPH

Provider Business Mailing Address
First Line	:	320 E HANES MILL RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9135
Country	:	US
Telephone Number	:	336-377-2349
Fax Number	:	336-377-2349

Provider Business Practice Location Address
First Line	:	320 E HANES MILL RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9135
Country	:	US
Telephone Number	:	336-377-2349
Fax Number	:	336-377-2349

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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