MEDICARE: MARINENA BONDURANT R.PH.

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	007952	KY

General Provider Information

NPI Number	:	1720123169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINENA BONDURANT R.PH.

Provider Business Mailing Address
First Line	:	707 COVENTRY TRL
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-1218
Country	:	US
Telephone Number	:	270-898-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 W PARK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9058
Country	:	US
Telephone Number	:	270-443-0909
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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Directions to “ MARINENA BONDURANT R.PH.” Practice Location

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