Provider Demographics
NPI:1215452487
Name:BONITTO, RIANNE A (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:RIANNE
Middle Name:A
Last Name:BONITTO
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10037 205TH PL
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3436
Mailing Address - Country:US
Mailing Address - Phone:347-726-0239
Mailing Address - Fax:
Practice Address - Street 1:11255 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2433
Practice Address - Country:US
Practice Address - Phone:718-465-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist