Provider Demographics
NPI:1528380904
Name:BONANNO-ERBETTA, VIVIAN ANNA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ANNA
Last Name:BONANNO-ERBETTA
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 1:6 TIORATI TRL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1745
Mailing Address - Country:US
Mailing Address - Phone:845-786-7173
Mailing Address - Fax:
Practice Address - Street 1:20 FILORS LN
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2706
Practice Address - Country:US
Practice Address - Phone:845-786-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist