Tony Leonard Bonillo, R.PH.
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Portland, OR
NPI 1508102435 · NPPES record last updated Apr 27, 2017
Key facts
- NPI
- 1508102435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- 0009214 (OR)
- Practice address
- 3030 NE Weidler St
Portland, OR 97232-1851 - Phone
- (503) 280-1333
- Fax
- (503) 280-1327
- NPI assigned
- Dec 20, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0009214 | OR | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0009214 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 0009214 | OR | Yes |
Addresses
Primary practice location
3030 NE Weidler St
Portland, OR 97232-1851
Mailing address
3030 NE Weidler St
Portland, OR 97232-1851
Phone (503) 280-1333
Other providers in Portland, OR
- Allison D Bonifay
- Amy Grace Bonilla
- Arielle Bonilla
- Brenda Bonilla
- Kathleen Mulloy Bonilla
- Kerry Bonin
- Teresa Bonn
- Ashley Bonnefin
- Joseph Bonnell
- Andrew D. Bonner
All providers in Portland, OR · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2017. 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.