MEDICARE: DR. CHARLES BONANNO PHARM. D.

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	1835G0303X	Geriatric Pharmacist	PU 5487	FL
2	1835P1200X	Pharmacotherapy Pharmacist	PS20670	FL

General Provider Information

NPI Number	:	1861498842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BONANNO PHARM. D.

Provider Business Mailing Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:	954-424-9782

Provider Business Practice Location Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:	954-424-9782

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/19/2023

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