Provider Demographics
NPI:1467737791
Name:BENNETT, DENNIS ROLANDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ROLANDO
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 AUDUBON VILLAGE SPUR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1722
Mailing Address - Country:US
Mailing Address - Phone:636-821-1969
Mailing Address - Fax:
Practice Address - Street 1:419 AUDUBON VILLAGE SPUR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1722
Practice Address - Country:US
Practice Address - Phone:636-821-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist