Provider Demographics
NPI:1205158359
Name:CHERRY, BONITA S (RPH)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:S
Last Name:CHERRY
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 1:1730 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1542
Mailing Address - Country:US
Mailing Address - Phone:631-348-2558
Mailing Address - Fax:631-348-7319
Practice Address - Street 1:1730 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1542
Practice Address - Country:US
Practice Address - Phone:631-348-2558
Practice Address - Fax:631-348-7319
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist