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General NPI Number Information
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NPI Number | 1831588615
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Entity Type | Individual
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Provider Name | MICHELLE L. BENNETT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 2655 SHASTA WAY
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-4455
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Country | US
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Telephone | 541-884-1086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5324
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City | KLAMATH FALLS
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State | OR
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Zip | 97601
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Country | US
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Telephone | 541-884-1086
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH81968
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0014258
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License Number State | OR
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