Provider Demographics
NPI:1013290881
Name:BONJEAN, MITCHELL (RPH)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BONJEAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1313
Mailing Address - Country:US
Mailing Address - Phone:262-363-5235
Mailing Address - Fax:
Practice Address - Street 1:212 N ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1313
Practice Address - Country:US
Practice Address - Phone:262-363-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12608-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist