Jessica R Bonifas, PHARMD
Individual provider Active NPI Pharmacist · Waconia, MN
NPI 1497752174 · NPPES record last updated Jul 10, 2010
Key facts
- NPI
- 1497752174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 118050-5 (MN)
- Practice address
- 851 Marketplace Dr
Waconia, MN 55387-1548 - Phone
- (952) 442-4407
- Fax
- (952) 442-5787
- NPI assigned
- Jul 7, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118050-5 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mackenthun Beck Pharmacy, Inc | Current | Accepting new patients |
Locations
851 Marketplace Dr
Waconia, MN 55387
Phone (952) 442-2512
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 118050-5 | MN | Yes |
Addresses
Primary practice location
851 Marketplace Dr
Waconia, MN 55387-1548
Mailing address
851 Marketplace Dr
Waconia, MN 55387-1548
Phone (952) 442-4407
Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.