Provider Demographics
NPI:1295824274
Name:MARTY, BONNIE J (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:MARTY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 KESTREL CT
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1231
Mailing Address - Country:US
Mailing Address - Phone:415-468-5447
Mailing Address - Fax:650-849-0309
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:PHARMACY DEPARTMENT - MAIL CODE 119
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-849-0309
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy