Provider Demographics
NPI:1457651358
Name:LANDRUM, BONNIE G (PHARMD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:G
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-7562
Mailing Address - Country:US
Mailing Address - Phone:303-646-0656
Mailing Address - Fax:303-646-0678
Practice Address - Street 1:220 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7562
Practice Address - Country:US
Practice Address - Phone:303-646-0656
Practice Address - Fax:303-646-0678
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist