Organization
BONNER'S PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILLIE JAMES BONNER (OWNER)
(662) 226-8825
Entity
Organization
Contact information
Practice address
1000 J K AVENT DR, GRENADA, MS 38901-5063
(662) 226-8825
Mailing address
1000 J K AVENT DR, GRENADA, MS 38901-5063
(662) 226-8825
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
01331
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0045101
—
MS
05
—
0094978
—
MS
Enumeration date
05/21/2007
Last updated
03/18/2008
Update your record
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