Provider Demographics
NPI:1376349282
Name:BONANNO, JOHN GERD (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GERD
Last Name:BONANNO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STAFFORDS XING
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9313
Mailing Address - Country:US
Mailing Address - Phone:518-360-3593
Mailing Address - Fax:
Practice Address - Street 1:549 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2105
Practice Address - Country:US
Practice Address - Phone:518-274-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist