MEDICARE: MR. STEVEN ANDREW BENETEAU R.PH

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	5302029629	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302029629	OTHER	MI	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1679661938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN ANDREW BENETEAU R.PH

Provider Business Mailing Address
First Line	:	9455 MALDEN RD
Second Line	:
City	:	LASALLE
State	:	ONTARIO
Zip	:	N9J 2W3
Country	:	CA
Telephone Number	:	519-734-0771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5688 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3219
Country	:	US
Telephone Number	:	313-565-9357
Fax Number	:	313-565-8457

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	05/17/2013

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