Provider Demographics
NPI:1740308386
Name:MIMMS, BONNIE STOGNER (RPH)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:STOGNER
Last Name:MIMMS
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 1:102 TERRAMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2759
Mailing Address - Country:US
Mailing Address - Phone:864-244-8339
Mailing Address - Fax:
Practice Address - Street 1:950 W FARIS RD
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4255
Practice Address - Country:US
Practice Address - Phone:864-255-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist