Provider Demographics
NPI:1932700218
Name:BONANNO, TAMMY JEAN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:BONANNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CENTRE OF NEW ENGLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6081
Mailing Address - Country:US
Mailing Address - Phone:401-823-7060
Mailing Address - Fax:
Practice Address - Street 1:650 CENTRE OF NEW ENGLAND BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6081
Practice Address - Country:US
Practice Address - Phone:401-823-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTRPH0007218183500000X
RI3398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist