Healthcare Provider Details

I. General information

NPI: 1972871085
Provider Name (Legal Business Name): JOHN ARISTIDE BIENVENU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E COMMERCE ST
HERNANDO MS
38632-2433
US

IV. Provider business mailing address

2850 OAK GROVE CV
HERNANDO MS
38632-8694
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-3349
  • Fax: 662-429-5835
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE09685
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: