Provider Demographics
NPI:1174807366
Name:ANTHONY, BONNIE (PHARMD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 LEAMORE SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4652
Mailing Address - Country:US
Mailing Address - Phone:757-630-3214
Mailing Address - Fax:
Practice Address - Street 1:4453 LEAMORE SQUARE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4652
Practice Address - Country:US
Practice Address - Phone:757-630-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist