Provider Demographics
NPI:1144516618
Name:BONILLA, ZULMA IDALIA (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:ZULMA
Middle Name:IDALIA
Last Name:BONILLA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CALLE HORTENSIA
Mailing Address - Street 2:MANSIONES DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7210
Mailing Address - Country:US
Mailing Address - Phone:787-755-3236
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS PLAZA ENCANTADA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-748-0013
Practice Address - Fax:787-748-1758
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist