Provider Demographics
NPI:1235612920
Name:BONKO, GERALD MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MICHAEL
Last Name:BONKO
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 1:19 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8233
Mailing Address - Country:US
Mailing Address - Phone:215-715-6893
Mailing Address - Fax:
Practice Address - Street 1:200 STEVENS DR
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19113-1520
Practice Address - Country:US
Practice Address - Phone:215-863-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy