Provider Demographics
NPI:1659715290
Name:BONACCORSI, FREDERICK CHARLES (RPH)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CHARLES
Last Name:BONACCORSI
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 1:33 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1549
Mailing Address - Country:US
Mailing Address - Phone:856-371-8477
Mailing Address - Fax:856-468-5298
Practice Address - Street 1:33 HOLLYBROOK DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1549
Practice Address - Country:US
Practice Address - Phone:856-371-8477
Practice Address - Fax:856-468-5298
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01596300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist