Provider Demographics
NPI:1528282076
Name:BONNER, SHAWN C (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:C
Last Name:BONNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 WHISPERING FOREST DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8375
Mailing Address - Country:US
Mailing Address - Phone:616-844-8204
Mailing Address - Fax:231-796-3835
Practice Address - Street 1:14700 US 31
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8390
Practice Address - Country:US
Practice Address - Phone:616-844-4184
Practice Address - Fax:616-844-4189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist