Healthcare Provider Details

I. General information

NPI: 1851608103
Provider Name (Legal Business Name): ANTOINE BONDIMA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY JUNCTION 371 AND ROUTE 9 CROWNPOINT HEALTHCARE FACILITY
CROWNPOINT NM
87313
US

IV. Provider business mailing address

PO BOX 58
CROWNPOINT NM
87313-0058
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-6344
  • Fax: 505-786-2526
Mailing address:
  • Phone: 267-745-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007467
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: