Provider Demographics
NPI:1396043717
Name:BONK, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BONK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 639
Mailing Address - Street 2:161 TAYLORS BRIDGE RD
Mailing Address - City:ODESSA
Mailing Address - State:DE
Mailing Address - Zip Code:19730-0639
Mailing Address - Country:US
Mailing Address - Phone:302-750-0825
Mailing Address - Fax:302-378-4187
Practice Address - Street 1:161 TAYLORS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:DE
Practice Address - Zip Code:19730-0639
Practice Address - Country:US
Practice Address - Phone:302-750-0825
Practice Address - Fax:302-378-4187
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist