Healthcare Provider Details

I. General information

NPI: 1326007048
Provider Name (Legal Business Name): GREGORY EDWARD BONNORONT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/11/2025
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

2799 W MASON RD
SIDNEY OH
45365-7301
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-4550
  • Fax: 937-497-7986
Mailing address:
  • Phone: 937-492-8929
  • Fax: 937-497-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-16395
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC15650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: