Provider Demographics
NPI:1437552460
Name:BONNER, JUANITA LYNETTE (PHARMD, RPH, BCMTMS)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:LYNETTE
Last Name:BONNER
Suffix:
Gender:F
Credentials:PHARMD, RPH, BCMTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-9302
Mailing Address - Country:US
Mailing Address - Phone:605-431-2711
Mailing Address - Fax:
Practice Address - Street 1:129 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-9302
Practice Address - Country:US
Practice Address - Phone:605-431-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3680183500000X
SD6153183500000X
COPHA.0020755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist