Provider Demographics
NPI:1770830796
Name:BONNER, WILLIAM C (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:BONNER
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 1:2320 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2214
Mailing Address - Country:US
Mailing Address - Phone:662-328-4300
Mailing Address - Fax:662-328-4306
Practice Address - Street 1:2320 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2214
Practice Address - Country:US
Practice Address - Phone:662-328-4300
Practice Address - Fax:662-328-4306
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-8207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS11547OtherMISSISSIPPI CONTROLLED REGISTRATION CS11547