Provider Demographics
NPI:1760503874
Name:BONNER, CHRISTIAN GOSWIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:GOSWIN
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 1:324 E ANTIETAM ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5754
Mailing Address - Country:US
Mailing Address - Phone:301-766-4167
Mailing Address - Fax:301-745-4164
Practice Address - Street 1:26 MADDEX SQUARE DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4321
Practice Address - Country:US
Practice Address - Phone:304-876-0505
Practice Address - Fax:304-876-8412
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439808183500000X
WVWV6243183500000X
VA020212955183500000X
MD15461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist