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Organization

BONNER PROFESSIONAL COMPOUNDING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SHERYL RICKARD (CHIEF EXECUTIVE OFFICER)
(208) 263-1441
Entity
Organization

Contact information

Practice address
520 N 3RD AVE, SANDPOINT, ID 83864-1507
(208) 265-1093
(208) 265-1031
Mailing address
520 N 3RD AVE, SANDPOINT, ID 83864-1507
(208) 265-1093
(208) 265-1031

Taxonomy

Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
1402CP
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1402CP
STATE BOARD OF PHARMACY
ID
01
BB8651526
CONTROLLED SUBSTANCE REGI
DC
Enumeration date
02/20/2007
Last updated
08/22/2020
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