Provider Demographics
NPI:1679661938
Name:BENETEAU, STEVEN ANDREW (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANDREW
Last Name:BENETEAU
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 1:9455 MALDEN RD
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9J 2W3
Mailing Address - Country:CA
Mailing Address - Phone:519-734-0771
Mailing Address - Fax:
Practice Address - Street 1:5688 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3219
Practice Address - Country:US
Practice Address - Phone:313-565-9357
Practice Address - Fax:313-565-8457
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029629OtherPHARMACIST LICENSE NUMBER