# BONNER'S PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538378468
- **Authorized official:** BILLIE JAMES BONNER (OWNER)
- **Authorized official phone:** (662) 226-8825

## Contact information

- **Practice address:** 1000 J K AVENT DR, GRENADA, MS 38901-5063
- **Practice address phone:** (662) 226-8825
- **Mailing address:** 1000 J K AVENT DR, GRENADA, MS 38901-5063
- **Mailing address phone:** (662) 226-8825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 01331 | MS | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 03/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0045101 | — | MS |
| 05 | — | 0094978 | — | MS |