Provider Demographics
NPI:1841475621
Name:PETERS, BONNIE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ANN
Last Name:PETERS
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 1:100 SARATOGA VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3737
Mailing Address - Country:US
Mailing Address - Phone:518-899-2002
Mailing Address - Fax:888-912-1668
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3737
Practice Address - Country:US
Practice Address - Phone:518-899-2002
Practice Address - Fax:888-912-1668
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist