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General NPI Number Information
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NPI Number | 1972871085
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Entity Type | Individual
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Provider Name | JOHN ARISTIDE BIENVENU PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 950 E COMMERCE ST
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City | HERNANDO
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State | MS
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Zip | 38632-2433
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Country | US
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Telephone | 662-429-3349
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Fax | 662-429-5835
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Provider Business Mailing Address
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Address Line | 2850 OAK GROVE CV
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City | HERNANDO
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State | MS
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Zip | 38632-8694
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Country | US
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Telephone |
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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 | E09685
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13216
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License Number State | TN
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