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General NPI Number Information
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NPI Number | 1962480806
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Entity Type | Individual
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Provider Name | DAVID M BENEDETTI RPH
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Gender | Male
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Dates
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Enumeration Date | 01/01/2006
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 300 LAFAYETTE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4650
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Country | US
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Telephone | 616-685-6105
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Fax | 616-685-8981
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Provider Business Mailing Address
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Address Line | 4588 RICHMOND ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-1114
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Country | US
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Telephone | 616-453-4734
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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 | 5302023124
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License Number State | MI
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