Provider Demographics
NPI:1063851426
Name:BONACH, WILLIAM JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:BONACH
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 1:1101 E 37TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2972
Mailing Address - Country:US
Mailing Address - Phone:218-262-6138
Mailing Address - Fax:218-262-6147
Practice Address - Street 1:1101 E 37TH ST STE 4
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2972
Practice Address - Country:US
Practice Address - Phone:218-262-6138
Practice Address - Fax:218-262-6147
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist