NPIMap

Organization Active NPI

Bonner Professional Compounding

  • Pharmacotherapy Pharmacist
  • Sandpoint, ID
National Provider Identifier
1093850877
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacotherapy PharmacistTaxonomy code 1835P1200X
License
1402CP Issued in ID
Legal business name
BONNER PROFESSIONAL COMPOUNDING
Practice address
520 N 3Rd Ave
Sandpoint, ID 83864-1507
Phone
(208) 265-1093
Fax
(208) 265-1031
NPI assigned
Feb 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sheryl Rickard
Title
Chief Executive Officer
Phone
(208) 263-1441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacotherapy PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 1835P1200X 1402CP ID Primary

Addresses

Primary practice location

520 N 3Rd Ave
Sandpoint, ID 83864-1507

Mailing address

520 N 3Rd Ave
Sandpoint, ID 83864-1507
Phone (208) 265-1093

Other identifiers 2

IdentifierTypeStateIssuer
1402CPOtherIDSTATE BOARD OF PHARMACY
BB8651526OtherDCCONTROLLED SUBSTANCE REGI

National Provider Directory

National Provider Directory
Tax ID family
Sandpoint Women's Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093850877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N 3RD AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641507",
            "telephone_number": "208-265-1093",
            "fax_number": "208-265-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 3RD AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641507",
            "telephone_number": "208-265-1093",
            "fax_number": "208-265-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNER PROFESSIONAL COMPOUNDING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICKARD",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "208-263-1441",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "ID",
            "license": "1402CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY",
            "identifier": "1402CP",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE REGI",
            "identifier": "BB8651526",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandpoint, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.