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NPI Code Detail

MEDICARE: DAVID BENNETT

MEDICARE: DAVID BENNETT
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
1183500000XPharmacist5302021378MI

General Provider Information

NPI Number : 1851673842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BENNETT
Provider Business Mailing Address
First Line : 917 W SAVIDGE ST
Second Line : UNIT 34
City : SPRING LAKE
State : MI
Zip : 49456-2624
Country : US
Telephone Number : 616-847-8520
Fax Number :
Provider Business Practice Location Address
First Line : 3610 PLAINFIELD AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-2402
Country : US
Telephone Number : 616-365-1221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 09/15/2011

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Directions to “ DAVID BENNETT ” Practice Location

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