Healthcare Provider Details

I. General information

NPI: 1881639185
Provider Name (Legal Business Name): BONITA SUE CAW RPH, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N MAYSVILLE AVE
ZANESVILLE OH
43701-6110
US

IV. Provider business mailing address

1108 EPPLEY AVE
ZANESVILLE OH
43701-5655
US

V. Phone/Fax

Practice location:
  • Phone: 740-455-8845
  • Fax:
Mailing address:
  • Phone: 740-452-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-21020
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: