Provider Demographics
NPI:1861498842
Name:BONANNO, CHARLES (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BONANNO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6137
Mailing Address - Country:US
Mailing Address - Phone:954-435-7200
Mailing Address - Fax:954-424-9782
Practice Address - Street 1:10016 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6137
Practice Address - Country:US
Practice Address - Phone:954-435-7200
Practice Address - Fax:954-424-9782
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU 54871835G0303X
FLPS206701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric