Provider Demographics
NPI:1467897124
Name:BONNETT, LOUIS MITCHELL
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MITCHELL
Last Name:BONNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 RICE MINE RD NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2648
Mailing Address - Country:US
Mailing Address - Phone:205-345-3455
Mailing Address - Fax:
Practice Address - Street 1:4715 RICE MINE RD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2648
Practice Address - Country:US
Practice Address - Phone:205-345-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist