Individual provider Active NPI

Bonnie Mary Marino, RPH

  • Pharmacist
  • Buffalo, NY
National Provider Identifier
1376672683
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
041355 Issued in NY
Practice address
511 Farber Lakes Dr
Buffalo, NY 14221-5779
Phone
(716) 635-7815
Fax
(716) 631-9636
NPI assigned
Mar 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 041355 NY Primary

Addresses

Primary practice location

511 Farber Lakes Dr
Buffalo, NY 14221-5779

Mailing address

332 Tracey LN
Grand Island, NY 14072-1946
Phone (716) 773-6857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
041355NYMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Wny Coordinated Medical Care PC PastSince Sep 28, 2021 Accepting new patients
Independent Health Association Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376672683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 TRACEY LN",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140721946",
            "telephone_number": "716-773-6857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 FARBER LAKES DR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142215779",
            "telephone_number": "716-635-7815",
            "fax_number": "716-631-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "BONNIE",
        "middle_name": "MARY",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "041355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.