Healthcare Provider Details

I. General information

NPI: 1710815410
Provider Name (Legal Business Name): DAVID BEBAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 HILLTOP RD
SAINT JOSEPH MI
49085-2839
US

IV. Provider business mailing address

2409 CORONATION DRIVE
OAKVILLE ONTARIO
L6H7N2
CA

V. Phone/Fax

Practice location:
  • Phone: 269-983-0315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: