Provider Demographics
NPI:1922308014
Name:BONANNI, LISA SUZANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SUZANNE
Last Name:BONANNI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 CINNAMON DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4550
Mailing Address - Country:US
Mailing Address - Phone:215-316-0316
Mailing Address - Fax:
Practice Address - Street 1:4000 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1600
Practice Address - Country:US
Practice Address - Phone:267-233-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043398L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist