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NPI Code Detail

MEDICARE: MR. CARL J BENNETT RPH

MEDICARE: MR. CARL J BENNETT RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist41709MO

General Provider Information

NPI Number : 1689959728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL J BENNETT RPH
Provider Business Mailing Address
First Line : 8571 WATSON RD
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-5218
Country : US
Telephone Number : 314-962-5545
Fax Number : 314-968-1704
Provider Business Practice Location Address
First Line : 8571 WATSON RD
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-5218
Country : US
Telephone Number : 314-962-5545
Fax Number : 314-968-1704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2011
Last Update Date : 10/20/2011

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