Provider Demographics
NPI:1164774659
Name:GADA, BONA BIRKI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BONA
Middle Name:BIRKI
Last Name:GADA
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 1:2410 W WILLOW ST
Mailing Address - Street 2:APT A203
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2410 W. WILLOW ST
Practice Address - Street 2:APT A203
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917
Practice Address - Country:US
Practice Address - Phone:404-516-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist