Healthcare Provider Details

I. General information

NPI: 1316906035
Provider Name (Legal Business Name): HUGH EDWARD BONNORONT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N MAIN AVE
SIDNEY OH
45365-2731
US

IV. Provider business mailing address

1641 W MASON RD
SIDNEY OH
45365-8399
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-4550
  • Fax: 937-497-7986
Mailing address:
  • Phone: 937-492-9010
  • Fax: 937-497-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-07791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: