Healthcare Provider Details

I. General information

NPI: 1033760368
Provider Name (Legal Business Name): KADIAN BENNETT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 ANNAS RETREAT
CHARLOTTE AMALIE VI
00802-2221
US

IV. Provider business mailing address

4030 ANNAS RETREAT
CHARLOTTE AMALIE VI
00802-2221
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-9255
  • Fax:
Mailing address:
  • Phone: 340-777-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number359
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: