Healthcare Provider Details

I. General information

NPI: 1699407692
Provider Name (Legal Business Name): STEPHEN DAVID BENDEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7795 EL CENTRO BLVD
LAS CRUCES NM
88012-9301
US

IV. Provider business mailing address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 203-623-5848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8874
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: