Provider Demographics
NPI:1447569421
Name:BONARD, TERRI A (RPH)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:A
Last Name:BONARD
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 1:3757 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2700
Mailing Address - Country:US
Mailing Address - Phone:561-746-2501
Mailing Address - Fax:561-746-6217
Practice Address - Street 1:3757 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2700
Practice Address - Country:US
Practice Address - Phone:561-746-2501
Practice Address - Fax:561-746-6217
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS19056OtherSTATE