Provider Demographics
NPI:1467983650
Name:BONNER, LORRE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LORRE
Middle Name:
Last Name:BONNER
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 1:320 E HANES MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9135
Mailing Address - Country:US
Mailing Address - Phone:336-377-2349
Mailing Address - Fax:336-377-2349
Practice Address - Street 1:320 E HANES MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9135
Practice Address - Country:US
Practice Address - Phone:336-377-2349
Practice Address - Fax:336-377-2349
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC303189OtherNABP