Healthcare Provider Details

I. General information

NPI: 1376638148
Provider Name (Legal Business Name): THOMAS A. BONITO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH ROAD VA MEDICAL CENTER
MANCHESTER NH
03104
US

IV. Provider business mailing address

128 FREMONT STREET
MANCHESTER NH
03103
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-626-6562
Mailing address:
  • Phone: 603-668-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2088
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: