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General NPI Number Information
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NPI Number | 1760084131
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Entity Type | Individual
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Provider Name | KIMBERLY JILL BONILLA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 1415 7TH ST S
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City | CLANTON
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State | AL
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Zip | 35045-3746
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Country | US
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Telephone | 205-755-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 9204 RETREAT CIR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-7336
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Country | US
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Telephone | 205-862-2591
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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 | 13472
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License Number State | AL
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