Provider Demographics
NPI:1447886932
Name:BONSU, PETER (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BONSU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 MAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5773
Mailing Address - Country:US
Mailing Address - Phone:678-468-6221
Mailing Address - Fax:
Practice Address - Street 1:34301 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3341
Practice Address - Country:US
Practice Address - Phone:334-636-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist