Provider Demographics
NPI:1881639185
Name:CAW, BONITA SUE (RPH, CGP)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:SUE
Last Name:CAW
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 EPPLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-5655
Mailing Address - Country:US
Mailing Address - Phone:740-452-2043
Mailing Address - Fax:
Practice Address - Street 1:19 N MAYSVILLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6110
Practice Address - Country:US
Practice Address - Phone:740-455-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist