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General NPI Number Information
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NPI Number | 1174892335
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Entity Type | Individual
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Provider Name | BARRY BONNER RPH
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Gender | Male
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Dates
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Enumeration Date | 12/17/2011
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Last Update Date | 12/17/2011
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Provider Practice Location Address
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Address Line | 18300 GOVERNORS HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2910
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Country | US
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Telephone | 708-799-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 18142 66TH CT APT 302
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City | TINLEY PARK
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State | IL
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Zip | 60477-4166
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Country | US
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Telephone | 708-704-4181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051291176
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License Number State | IL
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