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General NPI Number Information
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NPI Number | 1265715791
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Entity Type | Individual
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Provider Name | NICHOLAS EDMOND BENNETT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 8325 W INDIAN SCHOOL RD
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City | PHOENIX
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State | AZ
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Zip | 85037-2125
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Country | US
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Telephone | 623-245-7353
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Fax | 623-245-7347
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Provider Business Mailing Address
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Address Line | 2522 N RILEY RD
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City | BUCKEYE
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State | AZ
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Zip | 85396-1549
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Country | US
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Telephone | 623-570-1947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S018497
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License Number State | AZ
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