Provider Demographics
NPI:1023329174
Name:FORD, BONITA BRIDGETT (RPH)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:BRIDGETT
Last Name:FORD
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 1:3437 PALM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6328
Mailing Address - Country:US
Mailing Address - Phone:713-598-6776
Mailing Address - Fax:
Practice Address - Street 1:220 S WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4632
Practice Address - Country:US
Practice Address - Phone:713-924-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist