Provider Demographics
NPI:1649858614
Name:BONJOUR, DENISE ALEXANDRA (RPH)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ALEXANDRA
Last Name:BONJOUR
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 1:1408 PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566
Mailing Address - Country:US
Mailing Address - Phone:608-214-4203
Mailing Address - Fax:
Practice Address - Street 1:154 W. MAIN STREET LENA DRUG STORE
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048
Practice Address - Country:US
Practice Address - Phone:815-369-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11947-40183500000X
IL051038293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist