| NPI | 1063624922 |
|---|---|
| Doing Business As | BONNEVILLE PHARMACY AND HOME CARE |
| Entity Type | Organization |
| Authorized Contact | ROBERT F NETHERCOTE Owner President 860-774-9362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CT 159) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: CT 159) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |