Provider Demographics
NPI:1326314311
Name:KING-BONNER, MARIE PATSY (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:PATSY
Last Name:KING-BONNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-5928
Mailing Address - Country:US
Mailing Address - Phone:409-938-3787
Mailing Address - Fax:409-938-3836
Practice Address - Street 1:202 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-5928
Practice Address - Country:US
Practice Address - Phone:409-938-3787
Practice Address - Fax:409-938-3836
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist