Provider Demographics
NPI:1366471153
Name:BOND PHARMACY, INC.
Entity Type:Organization
Organization Name:BOND PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-796-3145
Mailing Address - Street 1:703 W BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-1227
Mailing Address - Country:US
Mailing Address - Phone:573-796-3145
Mailing Address - Fax:573-796-3185
Practice Address - Street 1:703 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1227
Practice Address - Country:US
Practice Address - Phone:573-796-3145
Practice Address - Fax:573-796-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600304505Medicaid
MO620304501Medicaid
MO600304505Medicaid