Provider Demographics
NPI:1770987208
Name:BONO, ANTHONY S (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:S
Last Name:BONO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BONO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:117 LUCY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1347
Mailing Address - Country:US
Mailing Address - Phone:847-726-7260
Mailing Address - Fax:
Practice Address - Street 1:117 LUCY CT
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1347
Practice Address - Country:US
Practice Address - Phone:847-726-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-032431OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION (PHARMACY LICENSE)