Provider Demographics
NPI:1811327646
Name:BONAPARTE PHARMACY, LLC
Entity type:Organization
Organization Name:BONAPARTE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BESAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-528-6659
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13648-0218
Mailing Address - Country:US
Mailing Address - Phone:315-537-5032
Mailing Address - Fax:315-537-5033
Practice Address - Street 1:8210 MAIN ST.
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:NY
Practice Address - Zip Code:13648
Practice Address - Country:US
Practice Address - Phone:315-537-5032
Practice Address - Fax:315-537-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032170OtherSTATE LICENSE
NY03822680Medicaid
NY032170OtherSTATE LICENSE