Provider Demographics
NPI:1124302641
Name:TORBERT, BONITA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:
Last Name:TORBERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1602
Mailing Address - Country:US
Mailing Address - Phone:314-725-6133
Mailing Address - Fax:
Practice Address - Street 1:7501 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-1602
Practice Address - Country:US
Practice Address - Phone:314-725-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist