Provider Demographics
NPI:1275212235
Name:BENEDICT, MARCI ANNETTE
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:ANNETTE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11732 SYLVESTER DR
Mailing Address - Street 2:
Mailing Address - City:ELSAH
Mailing Address - State:IL
Mailing Address - Zip Code:62028-7020
Mailing Address - Country:US
Mailing Address - Phone:618-802-0769
Mailing Address - Fax:
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-867-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist