Organization
BONNER PROFESSIONAL COMPOUNDING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY F. SNIDER RPH (PHARMACIST IN CHARGE)
(208) 265-1093
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
3336C0004X
Compounding Pharmacy
Primary
1402CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306718
NCPDS #
ID
01
—
1402CP
STATE LICENSE #
ID
Enumeration date
05/25/2007
Last updated
08/22/2020
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