Provider Demographics
NPI:1689326100
Name:BONNINGTON, LAURIE ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:BONNINGTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1107 FAIRWAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6109
Mailing Address - Country:US
Mailing Address - Phone:248-709-4183
Mailing Address - Fax:
Practice Address - Street 1:710 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2851
Practice Address - Country:US
Practice Address - Phone:231-348-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist