MEDICARE: SUSAN G BENNETT RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12479	NV

General Provider Information

NPI Number	:	1649390386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN G BENNETT RPH

Provider Business Mailing Address
First Line	:	8321 W HAMMER LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4606
Country	:	US
Telephone Number	:	702-525-2686
Fax Number	:	702-395-2646

Provider Business Practice Location Address
First Line	:	8321 W HAMMER LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4606
Country	:	US
Telephone Number	:	702-525-2686
Fax Number	:	702-395-2646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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