Provider Demographics
NPI:1497001671
Name:BONDIOLI, GENO (RPH)
Entity Type:Individual
Prefix:
First Name:GENO
Middle Name:
Last Name:BONDIOLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 PATRICK LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-7309
Mailing Address - Country:US
Mailing Address - Phone:262-758-2299
Mailing Address - Fax:
Practice Address - Street 1:S70W15775 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8352
Practice Address - Country:US
Practice Address - Phone:414-422-1359
Practice Address - Fax:414-422-1447
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist