Provider Demographics
NPI:1053692285
Name:BONAMINIO, PETER I (BS RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BONAMINIO
Suffix:I
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14680 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2510
Mailing Address - Country:US
Mailing Address - Phone:708-460-2021
Mailing Address - Fax:708-460-2974
Practice Address - Street 1:14680 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2510
Practice Address - Country:US
Practice Address - Phone:708-460-2021
Practice Address - Fax:708-460-2974
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist