Provider Demographics
NPI:1720182140
Name:BOND ENTERPRISES INC
Entity Type:Organization
Organization Name:BOND ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KVINSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-858-9941
Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:STE 120
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-858-9941
Mailing Address - Fax:253-853-7828
Practice Address - Street 1:4700 POINT FOSDICK DR NW STE 120
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-858-9941
Practice Address - Fax:253-853-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WACF000021463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6118806Medicaid
2106780OtherPK
0222280001Medicare NSC