Provider Demographics
NPI:1831535665
Name:BONHAM, BROOKE MEADE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MEADE
Last Name:BONHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1577
Mailing Address - Country:US
Mailing Address - Phone:734-676-6000
Mailing Address - Fax:
Practice Address - Street 1:29255 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:GIBRALTAR
Practice Address - State:MI
Practice Address - Zip Code:48173-9738
Practice Address - Country:US
Practice Address - Phone:734-675-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020312571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist