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NPI Code Detail

MEDICARE: ANTHONY WILLEM VAN DE VENTER

MEDICARE: ANTHONY WILLEM VAN DE VENTER
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
1183500000XPharmacist26021078AIN

General Provider Information

NPI Number : 1811592801
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY WILLEM VAN DE VENTER
Provider Business Mailing Address
First Line : 2650 S WALNUT ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-7302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2650 S WALNUT ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-7302
Country : US
Telephone Number : 812-336-6223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 11/30/2020

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Directions to “ ANTHONY WILLEM VAN DE VENTER ” Practice Location

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