Provider Demographics
NPI:1003680984
Name:BONDER, MAXIMILIAN JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:JOHN
Last Name:BONDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-4643
Mailing Address - Country:US
Mailing Address - Phone:224-659-1455
Mailing Address - Fax:
Practice Address - Street 1:3004 KIRCHOFF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1818
Practice Address - Country:US
Practice Address - Phone:847-818-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist