Healthcare Provider Details

I. General information

NPI: 1487251328
Provider Name (Legal Business Name): BONNIE ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MAIN STREET
EMLENTON PA
16373
US

IV. Provider business mailing address

603 MAIN STREET
EMLENTON PA
16373
US

V. Phone/Fax

Practice location:
  • Phone: 724-867-2400
  • Fax:
Mailing address:
  • Phone: 724-867-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040936L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: