Provider Demographics
NPI:1497351456
Name:BONCROSS, PETER CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHARLES
Last Name:BONCROSS
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 1:2702 ROUTE 130 N
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3091
Mailing Address - Country:US
Mailing Address - Phone:856-829-4877
Mailing Address - Fax:
Practice Address - Street 1:2702 ROUTE 130 N
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3091
Practice Address - Country:US
Practice Address - Phone:856-829-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02722700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist