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General NPI Number Information
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NPI Number | 1730286576
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Entity Type | Organization
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Legal Business Name | BONITA PHARMACY INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 4190 BONITA RD STE 101
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City | BONITA
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State | CA
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Zip | 91902-1329
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Country | US
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Telephone | 619-475-4112
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Fax | 619-475-4113
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Provider Business Mailing Address
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Address Line | 4190 BONITA RD STE 101
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City | BONITA
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State | CA
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Zip | 91902-1329
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Country | US
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Telephone | 619-475-4112
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Fax | 619-475-4113
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHRG
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Name | FRANK YEP
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Credential | RPH
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Telephone | 619-475-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY21603
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License Number State | CA
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