Basic Information
| Provider Information | |||||||||
| NPI: | 1851614325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALVAREZ | ||||||||
| FirstName: | BONITA | ||||||||
| MiddleName: | WONZIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 HARMON AVENUE | ||||||||
| Address2: | |||||||||
| City: | FT. STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356745 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1061 HARMON AVENUE | ||||||||
| Address2: | |||||||||
| City: | FT. STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356745 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | RPH023337 | GA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.