=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689348450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA C BONK RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2021
-----------------------------------------------------
Last Update Date | 08/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 MEMORIAL HWY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18612-9248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-675-4807
-----------------------------------------------------
Fax | 570-675-3741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 COLLINS AVE
-----------------------------------------------------
City | SHAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18708-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-466-2485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP-30513L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------