Provider Demographics
NPI:1801558366
Name:BONIN, CHELCIE LEMAIRE
Entity type:Individual
Prefix:
First Name:CHELCIE
Middle Name:LEMAIRE
Last Name:BONIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4578
Mailing Address - Country:US
Mailing Address - Phone:337-658-9722
Mailing Address - Fax:
Practice Address - Street 1:3400 MILITARY HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4230
Practice Address - Country:US
Practice Address - Phone:318-640-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist