Healthcare Provider Details

I. General information

NPI: 1831531433
Provider Name (Legal Business Name): ASHLEY BONNELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

16848 123RD AVE SE
RENTON WA
98058-6047
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax:
Mailing address:
  • Phone: 585-576-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 60382954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: