Provider Demographics
NPI:1427129063
Name:BOMBARDIER, ANTHONY L (PHARM D)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:BOMBARDIER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2717
Mailing Address - Country:US
Mailing Address - Phone:785-614-1449
Mailing Address - Fax:
Practice Address - Street 1:1020 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-3900
Practice Address - Country:US
Practice Address - Phone:785-243-4414
Practice Address - Fax:785-243-1827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist