Provider Demographics
NPI:1649789652
Name:PENA-BONILLA, CATHERINE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARIE
Last Name:PENA-BONILLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:365 COLE RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7919
Mailing Address - Country:US
Mailing Address - Phone:601-261-2244
Mailing Address - Fax:601-261-2245
Practice Address - Street 1:365 COLE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7919
Practice Address - Country:US
Practice Address - Phone:601-261-2244
Practice Address - Fax:601-261-2245
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MSE-15126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program