Provider Demographics
NPI:1558967497
Name:BENNETT, DAVID MACALPINE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MACALPINE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-0068
Mailing Address - Country:US
Mailing Address - Phone:520-490-0767
Mailing Address - Fax:
Practice Address - Street 1:1920 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3641
Practice Address - Country:US
Practice Address - Phone:906-779-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist