Provider Demographics
NPI:1922062124
Name:BONNER, CARLA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:BONNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8590 HEARN RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2339
Mailing Address - Country:US
Mailing Address - Phone:770-463-0313
Mailing Address - Fax:
Practice Address - Street 1:405 CARLTON RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1052
Practice Address - Country:US
Practice Address - Phone:770-463-4031
Practice Address - Fax:770-463-4946
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist