Provider Demographics
NPI:1487251328
Name:ANTHONY, BONNIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EMLENTON
Mailing Address - State:PA
Mailing Address - Zip Code:16373
Mailing Address - Country:US
Mailing Address - Phone:724-867-2400
Mailing Address - Fax:
Practice Address - Street 1:603 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EMLENTON
Practice Address - State:PA
Practice Address - Zip Code:16373
Practice Address - Country:US
Practice Address - Phone:724-867-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040936L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist