Provider Demographics
NPI:1285986968
Name:BONKOWSKI, WOJCIECH M (PHARMD)
Entity type:Individual
Prefix:MR
First Name:WOJCIECH
Middle Name:M
Last Name:BONKOWSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 BLACK MANGROVE DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1802
Mailing Address - Country:US
Mailing Address - Phone:810-919-4932
Mailing Address - Fax:
Practice Address - Street 1:6521 BLACK MANGROVE DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1802
Practice Address - Country:US
Practice Address - Phone:810-919-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist