| Organization Name: | BONNER PROFESSIONAL COMPOUNDING |
| NPI Number: | 1154532794 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY F. SNIDER (PHARMACIST IN CHARGE) |
| Mailing Address: | 520 N 3rd Ave Sandpoint |
| State: | ID US |
| Postal Code: | 838641507 |
| Phone Number: | 2082651093 |
| Fax Number: | 2082651031 |
| NPI Enumeration Date: | 05/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 1402CP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |