Provider Demographics
NPI:1518669217
Name:BONNER, WILL ALLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:ALLEN
Last Name:BONNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N ISAAC DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-6009
Mailing Address - Country:US
Mailing Address - Phone:662-328-4300
Mailing Address - Fax:662-328-4306
Practice Address - Street 1:115 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5220
Practice Address - Country:US
Practice Address - Phone:662-570-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-100817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist