| NPI | 1609095868 |
|---|---|
| Doing Business As | BONNEVILLE LTC |
| Entity Type | Organization |
| Authorized Contact | ROBERT NETHERCOTE President 508-450-3161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: CT 2085) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2010-06-09 |