Provider Demographics
NPI:1245236256
Name:BENNETT, MARIALICE SCHMITT (RPH)
Entity Type:Individual
Prefix:
First Name:MARIALICE
Middle Name:SCHMITT
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 W 10TH AVE
Mailing Address - Street 2:RM 1970A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-292-2425
Mailing Address - Fax:
Practice Address - Street 1:456 W 10TH AVE
Practice Address - Street 2:RM 1970A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-292-2425
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-092861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy