Provider Demographics
NPI:1881740371
Name:SYSLING-SALVADOR, BONNIE ANN (RPH)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANN
Last Name:SYSLING-SALVADOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1847
Mailing Address - Country:US
Mailing Address - Phone:313-882-1248
Mailing Address - Fax:
Practice Address - Street 1:31700 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7949
Practice Address - Country:US
Practice Address - Phone:586-276-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027495183500000X
AZ12265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist