MEDICARE: BONNIE YVONNE HOLDEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	49659	CA

General Provider Information

NPI Number	:	1124315007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE YVONNE HOLDEN PHARMD

Provider Business Mailing Address
First Line	:	2911 JAMACHA RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4342
Country	:	US
Telephone Number	:	619-315-0016
Fax Number	:	619-315-0016

Provider Business Practice Location Address
First Line	:	2911 JAMACHA RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4342
Country	:	US
Telephone Number	:	619-315-0016
Fax Number	:	619-315-0016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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