Provider Demographics
NPI:1083721021
Name:BONASERA, DARYL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
Last Name:BONASERA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SW CHANDLER TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4439
Mailing Address - Country:US
Mailing Address - Phone:772-344-2601
Mailing Address - Fax:
Practice Address - Street 1:3320 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6719
Practice Address - Country:US
Practice Address - Phone:772-283-1714
Practice Address - Fax:772-283-1790
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist