Provider Demographics
NPI:1639598196
Name:RATHI, BONITA WHAYUEN SHIN
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:WHAYUEN SHIN
Last Name:RATHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 S 44TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-4016
Mailing Address - Country:US
Mailing Address - Phone:602-431-5356
Mailing Address - Fax:866-653-0226
Practice Address - Street 1:4755 S 44TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4016
Practice Address - Country:US
Practice Address - Phone:602-431-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5012225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist