Organization
BONNEVILLE RX LLC
Active
Other names
BONNEVILLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RAVINDER ANNAMANENI (MEMBER)
(860) 774-9362
Entity
Organization
Contact information
Practice address
77 WESTCOTT RD, DANIELSON, CT 06239-2929
(860) 774-9362
(860) 779-2647
Mailing address
77 WESTCOTT RD, DANIELSON, CT 06239-2929
(860) 774-9362
(860) 779-2647
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PCY0000159
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138266
PK
—
Enumeration date
12/26/2006
Last updated
09/09/2013
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