| NPI | 1164587580 |
|---|---|
| Doing Business As | BONNEVILLE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RAVINDER ANNAMANENI Member 860-774-9362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CT PCY0000159) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2013-09-09 |