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General NPI Number Information
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NPI Number | 1740019066
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Entity Type | Individual
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Provider Name | ERIC BONAGUIDI
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Gender | Male
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 3605 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85018-7505
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Country | US
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Telephone | 602-275-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85018-7505
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Country | US
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Telephone |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | S011810
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License Number State | AZ
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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 | S011810
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License Number State | AZ
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