Provider Demographics
NPI:1376048124
Name:BONO FAMILY PHARMACY, LLC
Entity Type:Organization
Organization Name:BONO FAMILY PHARMACY, LLC
Other - Org Name:BONO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-8310
Mailing Address - Street 1:10040 HIGHWAY 63 S STE 4
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8669
Mailing Address - Country:US
Mailing Address - Phone:870-277-1543
Mailing Address - Fax:870-277-1527
Practice Address - Street 1:10040 HIGHWAY 63 S STE 4
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-8669
Practice Address - Country:US
Practice Address - Phone:870-277-1543
Practice Address - Fax:870-277-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
ARAR208763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176445OtherPK
AR225889407Medicaid