Provider Demographics
NPI:1487641965
Name:BONDHUS, STEPHEN L (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:BONDHUS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 E ROY ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3261
Mailing Address - Country:US
Mailing Address - Phone:480-515-3887
Mailing Address - Fax:
Practice Address - Street 1:1815 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8582
Practice Address - Country:US
Practice Address - Phone:602-335-2273
Practice Address - Fax:602-335-2267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist