Provider Demographics
NPI:1811033160
Name:BONFESSUTO, DARRYL M (RPH)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:M
Last Name:BONFESSUTO
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 1:701 OLDE HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4929
Mailing Address - Country:US
Mailing Address - Phone:717-569-7111
Mailing Address - Fax:717-569-3807
Practice Address - Street 1:701 OLDE HICKORY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4929
Practice Address - Country:US
Practice Address - Phone:717-569-7111
Practice Address - Fax:717-569-3807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032234L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist