Provider Demographics
NPI:1376672683
Name:MARINO, BONNIE MARY (RPH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARY
Last Name:MARINO
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 1:332 TRACEY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1946
Mailing Address - Country:US
Mailing Address - Phone:716-773-6857
Mailing Address - Fax:
Practice Address - Street 1:511 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-5779
Practice Address - Country:US
Practice Address - Phone:716-635-7815
Practice Address - Fax:716-631-9636
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist