MEDICARE: MR. ANTHONY S BONO R.PH.

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	051-032431	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051-032431	OTHER	IL	ILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION (PHARMACY LICENSE)

General Provider Information

NPI Number	:	1770987208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY S BONO R.PH.

Provider Business Mailing Address
First Line	:	117 LUCY CT
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1347
Country	:	US
Telephone Number	:	847-726-7260
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 LUCY CT
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1347
Country	:	US
Telephone Number	:	847-726-7260
Fax Number	:

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

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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